Measuring health care quality: Implications, threats, and opportunities for clinical pharmacists

Abstract

The Patient Protection and Affordable Care Act of 2010 has helped usher in an era of focus on health care quality and quality improvement. Since then, a variety of programs has driven quality improvement throughout the health care system using a combination of incentives and penalties. Many studies have demonstrated the value of integrating clinical pharmacist services into interdisciplinary models of care for the purpose of moving the needle on performance measures. The implementation of quality‐linked reimbursement programs has the greatest potential to meaningfully improve quality of care and reduce costs. However, the benefits of quality measures are dependent on their implementation into measurement systems and their application into clinical practice. Common threats to quality measurement in pharmacy practice may arise due to misapplication of health plan‐related measures to evaluate pharmacy services. Additionally, the core concepts related to novel reimbursement models have not adequately percolated into the formal education of practicing pharmacists. Therefore, the goal of this article is to help educate and raise awareness about the current quality landscape and present opportunities and directions for pharmacists to demonstrate their value in interdisciplinary health care teams. This article is broadly divided into four sections—first, we provide an introduction to quality measurement and its application to clinical pharmacists. Second, we elaborate on the development and endorsement of quality measures and measurement systems. Third, we present clinical scenarios of patient care—set in inpatient, ambulatory care, and community practice settings—that engage pharmacists in the context of quality measurement and evaluate the implications, threats, and opportunities for clinical pharmacists in each of these scenarios. Finally, we present recommendations for future advocacy, measurement, and leadership for pharmacist involvement in the quality landscape.

The impact of pharmacy benefit managers on community pharmacy: A scoping review

“… 11 This post-sale price adjustment is often called a “clawback” due to the fact that pharmacies are not able to plan for them and have no recourse once they are requested by the PBM. 13 , 14 …”