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

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.
• 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.