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Related Experiment Videos

Applying managed care performance measures in community pharmacy-based outcomes research.

K M Capó1, D R Rutledge

  • 1College of Pharmacy, University of Cincinnati, OH 45267-0004, USA. kristina.capo@uc.edu

Journal of the American Pharmaceutical Association (Washington, D.C. : 1996)
|June 11, 1999
PubMed
Summary

Community pharmacies can leverage the National Committee on Quality Assurance's (NCQA's) Health Employer Data and Information Set (HEDIS) for outcomes research. This approach can enhance pharmaceutical service acceptance and reimbursement by demonstrating shared goals with managed care organizations (MCOs).

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Area of Science:

  • Pharmacy Practice
  • Health Services Research
  • Quality Improvement

Background:

  • Managed care organizations (MCOs) increasingly require evidence of quality and effectiveness for pharmaceutical services.
  • Outcomes research is crucial for demonstrating the value of community pharmacy interventions.
  • The National Committee on Quality Assurance's (NCQA's) Health Employer Data and Information Set (HEDIS) offers a framework for performance measurement.

Purpose of the Study:

  • To introduce the Health Employer Data and Information Set (HEDIS) as a tool for community pharmacy outcomes research.
  • To demonstrate the practical application of HEDIS in an independent community pharmacy setting through case studies.

Main Methods:

  • Review of three distinct outcomes research projects conducted in an independent community pharmacy.

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  • Projects focused on areas such as ACE inhibitor use in heart failure, cardiovascular telepharmacy, and pediatric antibiotic callbacks, all utilizing HEDIS measures.
  • Data collection and analysis were tailored to HEDIS performance indicators.

    • Main Results:

    • The "Effectiveness of Care" component of HEDIS proved to be a practical tool for designing community pharmacy outcomes research.
    • Two of the three projects demonstrated improvements in clinical and/or service outcomes.
    • Implementation challenges were identified, but they related to project execution rather than the HEDIS tool itself.

    Conclusions:

    • Community pharmacists can utilize HEDIS to develop outcomes projects that align with the interests of MCOs seeking accreditation.
    • Demonstrating success through HEDIS-based research can facilitate acceptance and reimbursement for pharmaceutical services.
    • This approach empowers pharmacists to develop effective reimbursement strategies by showcasing shared objectives with MCOs.