Piloting PQA Pharmacy Measure Concepts for Blood Pressure and Hemoglobin A1C in Payer-Pharmacy Value-Based Arrangements
PQA completed two proof-of-concept pilots that implemented two blood pressure and two hemoglobin A1C pharmacy measure concepts in value-based payment arrangements (VBAs) between payers and pharmacies. The results are detailed in this report.
The pilot participants were Kroger in collaboration with Kroger Prescription Plans and Arkansas Blue Cross Blue Shield in collaboration with its regional pharmacy networks. More than 100,000 patients and more than 2,000 pharmacists were included in the pilot.
Measure improvement from the pilot’s baseline through the one-year endpoint was achieved by both pilot participants across all reportable measures. This demonstrates the positive influence of pharmacies on these measure concepts, which align with biomarker measures for diabetes and hypertension included in the Centers for Medicare & Medicaid Services Universal Foundation and the Medicare Star Ratings program.
Both pilot participants were able to calculate the measure concepts for A1C and blood pressure control and exchange data between payers and pharmacies. However, there were challenges in calculating the measure concepts for A1C and blood pressure improvement because discrete lab values for A1C were not consistently available and not available for blood pressure. As a result, the blood pressure improvement measure was not calculated.
The pilots were conducted through the PQA Quality Innovation and Research Center and leveraged the center’s unique approaches and resources to address challenges in developing, testing and refining complex measure concepts. This work was completed with financial support from the Community Pharmacy Foundation and Kroger Health and in-kind services by PQA.
Download the Report