Summerpal Kahlon, MD

Quality metrics for desired patient outcomes guide the collaborative efforts of the health care team.

As value-based health care reform gains momentum, care collaboration continues to evolve into a way of life for modern health care practices. Quality achievement, particularly for chronic diseases, increasingly requires a team-based approach that pairs diverse knowledge and regular engagement to optimize outcomes. Medications hold many chronic diseases at bay, for this reason, there is a natural synergy in ambulatory physician—pharmacist collaboration.

The solution to the multifaceted, dynamic problem of medication adherence cannot be achieved by a single practitioner or approach. A variety of chronic disease-oriented quality metrics either directly or indirectly require medication adherence programs in order to achieve successful outcomes. For example, the National Quality Forum endorses a ratio metric for asthmatics to maintain therapy with controller medications.

A study by Gums et al at the University of Iowa provides good evidence supporting the positive impact by pharmacists from both engaging patients and collaborating with physicians to optimize treatment plans.

 With 25.5 million asthmatics nationwide, according to the Centers for Disease Control and Prevention (CDC), the significant improvement in maintenance medication use, as well as reduction in hospital admissions among the 126 patients in the study, hints at a profound potential impact nationally if similar physician—pharmacist collaborative management programs can be scaled. Undoubtedly, quality metrics for other chronic diseases can reveal similar positive results from physician–pharmacist collaboration.

As an adult infectious diseases specialist, I am all too familiar with the challenges involved in achieving desired vaccination rates. Data from the Behavioral Risk Factor Surveillance System, published by the CDC, show that from 2009/2010 to 2012/2013, adult influenza vaccination rates rose from 40.4% to 41.5%; not only is the rise modest, but less than half of American adults received an influenza vaccination each season.

 Since the CDC recommends nearly all Americans over the age of 6 months receive the influenza vaccine annually, clearly there is room for improvement.

The Centers for Medicare & Medicaid Services certainly expect more from the Medicare Advantage health plans, as illustrated by the star ratings metric; 5-star plans will be expected to achieve influenza vaccination rates of greater than 79%, according to the 2015 Technical Notes.

 How could a plan possibly outperform the national average to such a great degree? One answer lies in the convenient setting of the community pharmacy, where the CDC indicates 21.9% of Americans received their influenza vaccination in 2013-2014.

 As part of broad, varied outreach programs, coordination of those vaccinations between pharmacist and physician, in the form of data sharing and reinforcement of related primary health maintenance, is a notable aspect of 5-star plans today.

Ultimately, a quality metric is simply a statistical representation of desired outcomes for a population. At the heart of these metrics, providers and their care processes must adapt in order to make a meaningful impact on individual members of a population. Within those processes lie unique adaptations, clinical programs, and coordinated professionals that drive positive, sustainable improvements in quality over time. Communication and collaboration remain essential in achieving health outcome improvements.

Summerpal Kahlon, MD, currently serves as vice president of business development at RelayHealth Pharmacy Solutions, with a focus on physician—pharmacist connectivity to support safe and appropriate medication management and care coordination across care settings.

		Gums TH, Carter BL, Milavetz G, et al. Physician-pharmacist collaborative management of asthma in primary care. 

. 2014;34(10):1033-1042. doi: 10.1002/phar.1468.

		Centers for Disease Control and Prevention. Flu vaccination coverage, United States, 2012-13 influenza season. Atlanta, GA: Centers for Disease Control and Prevention. Updated September 25, 2013. 

www.cdc.gov/flu/fluvaxview/coverage-1213estimates.htm

		Centers for Medicare & Medicaid Services. Medicare 2015 Part C & D Star Rating Technical Notes. Baltimore, MD: Centers for Medicare & Medicaid Services. Updated October 3, 2014. 

http://cdn5.medicarehelp.org/wp-content/uploads/2014/10/2015_Tech_Notes_2014_10_03.pdf

		Centers for Disease Control and Prevention. National early season flu vaccination coverage, United States, November 2013. Atlanta, GA: Centers for Disease Control and Prevention. Updated December 12, 2013. 

www.cdc.gov/flu/fluvaxview/nifs-estimates-nov2013.htm

Summerpal Kahlon, MD

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