Relative contribution of pharmacists and primary care providers to shared quality measures
Background: Alternative payment models are common for both primary care providers and pharmacies. These models rely on quality measures to determine reimbursement, and pharmacists and primary care providers can contribute to performance on a similar set of medication-related measures. Therefore, pay...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | Exploratory Research in Clinical and Social Pharmacy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667276622000646 |
| _version_ | 1818016919053139968 |
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| author | Benjamin Y. Urick Shweta Pathak Seth D. Cook Valerie A. Smith Patrick J. Campbell Mel L. Nelson Lee Holland Matthew K. Pickering |
| author_facet | Benjamin Y. Urick Shweta Pathak Seth D. Cook Valerie A. Smith Patrick J. Campbell Mel L. Nelson Lee Holland Matthew K. Pickering |
| author_sort | Benjamin Y. Urick |
| collection | DOAJ |
| description | Background: Alternative payment models are common for both primary care providers and pharmacies. These models rely on quality measures to determine reimbursement, and pharmacists and primary care providers can contribute to performance on a similar set of medication-related measures. Therefore, payers need to decide which provider to incentivize for which measures when both are included in alternative payment models. Objectives: To explore the relative contribution of pharmacies and primary care group practices to a range of quality measures. Methods: This retrospective cross-sectional study used Medicare Part A, B, and D claims for a 20% random sample of Medicare beneficiaries for 2014–2016. Eight quality measures were selected from the Merit-based Incentive Payment System and Medicare Part D Stars Ratings. Measures included medication adherence measures, appropriate prescribing measures such as high-risk medication use in the elderly, statin use in persons with diabetes (SUPD), and others. The residual intraclass correlation coefficient (RICC) was used to estimate the contribution of pharmacists and primary care providers to measure variation. To estimate the relative contribution across provider types, the pharmacy RICC was divided by the group practice RICC to yield a RICC ratio. Results: Due to varying measure eligibility requirements, the number of patients per measure ranged from 179,430 to 2,226,129. Across all measures, the RICC values were low, ranging from 0.013 for SUPD to 0.145 for adult sinusitis. Adherence measures had the highest RICC ratios (1.15–1.44), and the annual influenza vaccination measure had the lowest (0.56). Discussion and conclusions: The relative contributions of pharmacists and primary care providers vary across quality measures. As payers design payment models with measures to which pharmacists and primary care providers can contribute, the RICC ratio may be useful in aligning incentives to the providers with the greatest relative contributions. Additional research is needed to validate this method and extend it to additional sets of providers. |
| first_indexed | 2024-04-14T07:19:54Z |
| format | Article |
| id | doaj.art-796bd4c196fe488d936144dc0c42ebc6 |
| institution | Directory Open Access Journal |
| issn | 2667-2766 |
| language | English |
| last_indexed | 2024-04-14T07:19:54Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Exploratory Research in Clinical and Social Pharmacy |
| spelling | doaj.art-796bd4c196fe488d936144dc0c42ebc62022-12-22T02:06:12ZengElsevierExploratory Research in Clinical and Social Pharmacy2667-27662022-09-017100165Relative contribution of pharmacists and primary care providers to shared quality measuresBenjamin Y. Urick0Shweta Pathak1Seth D. Cook2Valerie A. Smith3Patrick J. Campbell4Mel L. Nelson5Lee Holland6Matthew K. Pickering7Prime Therapeutics, LLC, Eagan, MN, United States of America; University of North Carolina Eshelman School of Pharmacy, United States of America; Corresponding author at: 2900 Ames Crossing Rd, Eagan, MN 55121, United States of America.University of North Carolina Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, United States of AmericaThe Dedham Group, NY., United States of AmericaDivision of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States of AmericaMerck & Co., Kenilworth, NJ, United States of AmericaPharmacy Quality Alliance, Alexandria, VA, United States of AmericaXogene, Englewood, NJ, United States of AmericaNational Quality Forum, Washington, DC, United States of AmericaBackground: Alternative payment models are common for both primary care providers and pharmacies. These models rely on quality measures to determine reimbursement, and pharmacists and primary care providers can contribute to performance on a similar set of medication-related measures. Therefore, payers need to decide which provider to incentivize for which measures when both are included in alternative payment models. Objectives: To explore the relative contribution of pharmacies and primary care group practices to a range of quality measures. Methods: This retrospective cross-sectional study used Medicare Part A, B, and D claims for a 20% random sample of Medicare beneficiaries for 2014–2016. Eight quality measures were selected from the Merit-based Incentive Payment System and Medicare Part D Stars Ratings. Measures included medication adherence measures, appropriate prescribing measures such as high-risk medication use in the elderly, statin use in persons with diabetes (SUPD), and others. The residual intraclass correlation coefficient (RICC) was used to estimate the contribution of pharmacists and primary care providers to measure variation. To estimate the relative contribution across provider types, the pharmacy RICC was divided by the group practice RICC to yield a RICC ratio. Results: Due to varying measure eligibility requirements, the number of patients per measure ranged from 179,430 to 2,226,129. Across all measures, the RICC values were low, ranging from 0.013 for SUPD to 0.145 for adult sinusitis. Adherence measures had the highest RICC ratios (1.15–1.44), and the annual influenza vaccination measure had the lowest (0.56). Discussion and conclusions: The relative contributions of pharmacists and primary care providers vary across quality measures. As payers design payment models with measures to which pharmacists and primary care providers can contribute, the RICC ratio may be useful in aligning incentives to the providers with the greatest relative contributions. Additional research is needed to validate this method and extend it to additional sets of providers.http://www.sciencedirect.com/science/article/pii/S2667276622000646Outcome assessmentPrimary health careCommunity pharmaciesMedication adherence |
| spellingShingle | Benjamin Y. Urick Shweta Pathak Seth D. Cook Valerie A. Smith Patrick J. Campbell Mel L. Nelson Lee Holland Matthew K. Pickering Relative contribution of pharmacists and primary care providers to shared quality measures Exploratory Research in Clinical and Social Pharmacy Outcome assessment Primary health care Community pharmacies Medication adherence |
| title | Relative contribution of pharmacists and primary care providers to shared quality measures |
| title_full | Relative contribution of pharmacists and primary care providers to shared quality measures |
| title_fullStr | Relative contribution of pharmacists and primary care providers to shared quality measures |
| title_full_unstemmed | Relative contribution of pharmacists and primary care providers to shared quality measures |
| title_short | Relative contribution of pharmacists and primary care providers to shared quality measures |
| title_sort | relative contribution of pharmacists and primary care providers to shared quality measures |
| topic | Outcome assessment Primary health care Community pharmacies Medication adherence |
| url | http://www.sciencedirect.com/science/article/pii/S2667276622000646 |
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