Lessons Learned from Using Global Outcome Measures to Assess Community Pharmacy Performance

Area of Science:

• Health Services Research
• Pharmacy Practice

Background:

• Growing interest in value-based and alternative payment models necessitates pharmacy performance measurement.
• Existing systems often use process or surrogate measures not always relevant to patients and payers.
• Limited research exists on developing and implementing pharmacy performance measurement systems.

Purpose of the Study:

• To describe the design and implementation of a pharmacy performance measurement program.
• To assess the program's ability to measure quality using medication adherence, hospitalizations, emergency department visits, and total medical costs.
• To compare performance scores between enhanced services pharmacies and other pharmacies in North Carolina.

Main Methods:

• Developed a composite performance measurement system for enhanced services pharmacies.
• Utilized medication adherence, hospitalizations, emergency department visits, and total medical cost data.
• Calculated an 11-point composite pharmacy performance score.
• Compared scores for 119 enhanced services pharmacies against 1,616 other North Carolina pharmacies.

Main Results:

• The program successfully measured quality across a broad range of pharmacies.
• Enhanced services pharmacies demonstrated significantly higher medication adherence scores (P < 0.0001-0.003).
• No significant difference was found in mean total performance scores between enhanced services pharmacies (6.54) and other pharmacies (6.29; P = 0.115).

Conclusions:

• Composite outcome measurement is feasible across a large pharmacy network.
• The system supports alternative pharmacy payment models and demonstrates the possibility of case-mix adjustment.
• Collaboration between academics, pharmacists, and payers is valuable for advancing pharmacy performance measurement.