“Few concepts are as integral to the foundations
of health care reform as quality of care concerns and
related initiatives designed to measure, track and impose
incentives or restrictions on health care facilities, physicians
and insurers based on quality results,” states a May
10 analysis of PPACA from the law firm McDermott
Will & Emery.
The new law, for example, requires the Department
of Health and Human Services (HHS) to develop
national priorities for quality performance improvements
and to develop new quality measures and metrics for
providers of health care services. The law also requires
stakeholders—including insurers and managed care
organizations—to compile, report and receive payment
adjustments related to quality metrics.
For managed care pharmacy, the law clears a path
for the increased use of pharmacy quality measures in
determining payments to insurers and for managed care
organizations to determine payments to pharmacies and
other providers, according to the Academy of Managed
Care Pharmacy (AMCP).
The establishment of an Interagency Working Group
on Health Care Quality, for example, will provide
a platform for collaboration among agencies, avoid
duplication and assess quality efforts, explained Marissa
Schlaifer, director of pharmacy affairs at AMCP. It
will support research, technical assistance and process
implementation grants awarded through the Agency
for Healthcare Research and Quality (AHRQ). Grants
funded under this program will identify, develop, evaluate,
disseminate and provide training in innovative
methodologies and strategies for quality improvement
practices in the delivery of health care services.
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“The language in the legislation emphasizes the
importance of the work that the Academy has been
doing as an active member of the Pharmacy Quality
Alliance and the National Quality Forum,” Schlaifer
added.
The managed care pharmacy profession, in fact, is
well suited to address the quality provisions in the law,
including those tied to payment reforms, according to
one influential health care policy expert.
The law “provides some very important, unprecedented
opportunities” to support better quality and
lower costs in health care delivery, said Mark McClellan,
MD, PhD, Senior Fellow and Director of the Engelberg
Center for Healthcare Reform at The Brookings
Institution.
To accomplish these goals, managed care pharmacists
and other stakeholders should place their emphasis on
establishing patient-level quality measurements, which
link to the “overall outcomes [and] the overall results
for patients in the actual delivery of care and in our
payment system,” McClellan told attendees of AMCP’s
22nd Annual Meeting & Showcase in San Diego, Calif.,
in April.
Initiatives focused on overall quality improvement in
health care already are taking place around the country.
McClellan, a former CMS administrator and FDA
commissioner, pointed to one such program in which
laboratories, pharmacies, primary care providers and
specialists all share elements of data for use in the overall
management of the patient.
Such shared data can produce a more comprehensive
measure of quality and health outcomes for the individual
patient, McClellan explained. “That’s where we’re
headed, to get to this bigger emphasis on outcomes of
care and measures that reflect outcomes at the person
level, not just looking at silos of care.”
Health care stakeholders, meanwhile, should assess
the impact of the law’s provisions on existing quality
processes, other experts say.
“The establishment of quality measures and criteria
referenced in the [law] will be a significant undertaking
for the federal government, and will serve to both
clarify the extent of the impact of quality on the health
care system and better identify the potential burdens
and benefits of the legislation for the key players in the
health care marketplace,” according to McDermott Will
& Emery.
To learn more of AMCP’s activities related to pharmacy
quality improvement, visit www.amcp.org. |
