Quiz 6: SBAS

How does the National Academy of Medicine define quality healthcare?

the degree to which healthcare services increase the likelihood of desired outcomes and are consistent with current professional knowledge

What are the four goals of the Quadruple Aim?

1. enhance patient experience

2. improve population health

3. reduce healthcare costs

4. improve provider work life

How does CMS define quality measures?

tools that quantify healthcare processes, outcomes, patient perceptions, and systems linked to high-quality care or quality goals

What are the main purposes of quality measures?

- evaluate performance of health systems

- hold providers accountable

- improve patient satisfaction

- determine reimbursements and network status

What defines fee-for-service payment?

providers are reimbursed for the number of services or procedures provided

What defines pay-for-performance (value-based payment)?

reimbursement is tied to metric-driven outcomes, best practices, and patient satisfaction

Which legislation accelerated value-based payment adoption?

Affordable Care Act (ACA)

What is the role of accrediting organizations?

develop evidence-based quality measures and require reporting to achieve recognition or reward levels

What are the 4 major accrediting organization?

NQF, NCQA, AHRQ, CMS, and PQA (pharmacy-specific)

What does PQA focus on?

medication safety, adherence, and appropriateness used across many pharmacy settings

Which pharmacy settings are influenced by quality measures?

all settings - Part D, hospitals, clinics, and PBMs

How can poor performance impact hospitals?

hospitals with high readmission rates can face a 3% Medicare payment reduction

Why are pharmacists critical to quality measure success?

they are medication experts, highly accessible, and skilled in optimizing drug therapy and interprofessional collaboration

What does the "Circle of Life" represent in quality measures?

an iterative process of developing, evaluating, adjusting, and redeploying measures

Who collaborates to standardize quality metrics?

payers, pharmacists, and accrediting organization

What are the 4 types of quality measure programs?

Community Measures, HEDIS, CMS, and EQuIPP

What does HEDIS stand for and who sponsors it?

Healthcare Effectiveness Data and Information Set, sponsored by NCQA

What are typical HEDIS domains pharmacists can affect?

asthma medication use, beta-blocker therapy post-MI, BP control, diabetes screening, breast cancer screening

What two main community measures are tracked at CUHCC?

D5 (Diabetes) and V4 (Vascular Health)

What five components make up the D5 measure?

- BP <140/90

- statin use

- A1C <8%

- Tobacco-free

- Aspirin as recommended

What four components make up the V4 measure?

- BP <140/90

- statin use

- tobacco-free

- aspirin as recommended

What pharmacist-led initiatives improved CUHCC quality scores?

- depression screening documentation fixes

- remote BP monitoring program

- refined diabetes follow-up workflow

- asthma management updates

- targeted outreach for statin and aspirin use

What must ACOs report annually to CMS?

quality data to share savings and avoid losses

What are the five ACO quality metric?s

A1C, colorectal cancer screening, immunizations, BP control, and breast cancer screening

What is a limitation of using a single data point?

it may not represent overall patient progress or ongoing care

Why is documentation essential for quality reporting?

“If you didn’t document it, you didn’t do it” - data not entered properly won’t count in reports

What is the "denominator problem"?

patients attributed to a clinic but no longer active still count in reporting, skewing percentages

What is the goal of UMN's involvement in quality metrics?

to optimize medication outcomes through provider-payer partnerships

What is the focus of the ALIGN Summit?

identifying and adopting metrics aligned with the Quintuple Aim to measure medication management value

What earlier program helped inspire ALIGN?

SLICE of PI, which partnered with payers to align payment with pharmacy care quality