Drug Claims Data and Quality Measurement

Drug Claims Data and Quality Measurement Edward Westrick, MD, PhD MagnaCare Health Services Improvement, Inc 1 Drug Claims Data and Quality Measurement • Background – 2 MassPRO special projects • SCRIPT Project • Dually Enrolled • Data • Uses in MMA • Recommendations 2 Edward Westrick, MD, PhD • Internal Medicine • Pharmepi & Pharmecon • HCQIP – – – – – Quality Partners MassPRO IQH SCRIPT Project AHQA • MAS X • Leadership-Liaison • National Panels/Boards – USP • Medicare Model Guidelines Committee • Therapeutic Decision Making – NCQA • Medication Management Technical Subgroup – BPS • Board Cert Pharm – IOM • Leading By Example . . . • PBM • DUR • P&T Patient Safety: Medication Use – FMEA – VistA in state hospital system 3 Background: SCRIPT Project • Blue Bell Meeting1996 – Medication Use in Managed Care – Thought of Prescription Drug Benefit (someday) • “Polypharmacy Meeting” 1997 – Steering Workgroup – Measures Workgroup – Interventions Workgroup • Need for Common Set of Measures Used by All Stakeholders – SCRIPT Project • Test measures – Coalition for Quality in Medication Use • Leverage their use www.scriptproject.org 4 Coalition for Quality in Medication Use Member Organizations • • • • • • • • • • • • • • AMCP AHRQ AAAAI AAFP AAP AACE AAHP AARP ACAAI ACC ACCP ACG ACMQ ACP-ASIM • • • • • • • • • • • • • • ACPM ACR AGA AHQA AHA AMA AMDA AMGA ANA APhA APA ASAM ASA ASCP •ASHSP •ASH •AUA •BCBSA •CDC •CAP •CMS •DOD •DSS •DVA •FDA •HRSA •IHS •JCAHO •MGMA •NACDS •NCCC •NCQA •NCPA •NCL •NPSF •NPC •NQF •OPM •PCMA •USP 5 Coalition Sub-Groups • • • • • Science Advisors Steering Committee Criteria Workgroup Subcommittee for Models and Testing Subcommittee for Use of Performance Measures • Applications Group • Pharmaceutical Industry Council • Technical Expert Panel 6 SCRIPT Project • Two Phases – Measure ID and Selection • JCAHO – Measure Testing • MassPRO 7 Beta Testing • Ambulatory Setting • Managed Care and FFS • Three Conditions – CAD; CHF; AFib (post MI, dyslipidemia, hypertension) 8 States Massachusetts New York Mississippi Louisiana Minnesota Washington Oklahoma West Virginia 8 • Sampling – 400 cases per condition • ~5000 charts abstracted Beta-Blocker Prescribing in Post-Myocardial Infarction: With and Without Exclusions 100 90 80 70 60 50 40 30 20 10 0 91 81 69 62 69 70 76 76 76 82 71 59 63 82 74 81 BB Use without exclusions BB Use with exclusions B C D E Collaborator F G H All 9 Achieving at Least the Target Dose of ACEI 100 All CHF 80 % LVSD 60 48 46 51 49 49 38 31 31 44 34 29 43 39 44 43 38 40 20 0 A C D Collaborator E F G H All 10 Percent of Follow-Up INR Tests Within 7 Days Following an Out-Of-Range Test (INR > 4.0) 100 80 60 43 % w Follow-up INR within 7 days Mean (31 %) 40 21 29 27 8.8 20 0 A B Collaborator C E G 11 End of Project • Presentation to Coalition in October 2001 was Disrupted by 9/11 • Final Report Feb 2002 – Recommendations • Reconvene the Coalition for Quality in Medication Use – Present Work of the SCRIPT Project – Discuss Plans for the Future » » » » Use of Measures Validation of Measures New Measures Interventions • Outreach – Presentations at National Meetings – Peer Reviewed Publications – NQMC 12 Special Project in Dually Enrolled • Demonstrate how merging Medicare and Medicaid data can be useful in quality improvement – Disparities Studies – Medication Use Studies Medication Use Studies Analysis Logic for Administrative Data from SCRIPT Project 13 SCRIPT Measures    Coronary Artery Disease  Beta Blockers  ACEI  Lipid Rx  Lipid Test Heart Failure  ACEI  Beta Blockers  Other Meds  Monitoring K, RF Atrial Fibrillation  Warfarin  Monitoring K, RF, INR 14 SCRIPT: Study of Clinically Relevant Indicators for Pharmacologic Therapy: CMS Funded Pilot Project Medication Use in Heart Failure Dually Enrolled 100 80 60 40 20 0 E AC I Dig r yd H te tr a /Ni B AR o ron i Sp Di cs eti ur BB Heart Failure: Medication Use 15 ACEI in Heart Failure DE 100 80 Percent 60 40 20 0 1995 1996 1997 Heart Failure with ACEI Rx 1998 1999 16 Multi Year Group Practice Statewide Comparison: SCRIPT Indicator 17 Warfarin in Atrial Fibrillation Statewide Multi Year SCRIPT Measures 100 80 Percent 60 DE 40 20 0 1995 1996 1997 AFIB w Warfarin 1998 1999 18 Lipid Lowering Therapy in CAD with Dyslipidemia Statewide Multi Year SCRIPT Measures 100 80 60 Percent DE 40 20 0 1995 1996 1997 1998 1999 19 Dyslipidemia w Lipid Lowering Rx: CAD LDL-C Testing in CAD Multi Year Statewide SCRIPT Indicator Rates 100 80 Percent 60 DE 40 20 0 1995 1996 1997 1998 CAD w Cholesterol Test 1999 20 Group Practice Statewide Comparison: SCRIPT 21 Data Needed to Compose Measures • Diagnoses and Procedures from Parts A & B • Pharmacy Claims from Medicaid – – – – – – – Medication Name Dispensing Date Strength Days Supply Quantity Dispensed Prescriber Pharmacy Will need to have equivalent elements from MMA implementation 22 Recommendations • Develop Measurement System for Multiple Levels of Analysis Using Claims Data – – – – – – – – – National State Practice Plan Year Criterion Validity – Chart Abstraction Construct Validity – Longitudinal Claims-based Analyses Content Validity – Expert Panels, Lit Reviews Face Validity – Expert Panels • Validate the Claims-based Measures • Develop System Using Dually Enrolled Population, in Preparation for Eventual Use in MMA 23 Use of Measures at Different Levels of Analysis • National – CMS, Congress, NHQR • ? Plan – Accountability • State – QIO Evaluation in Future SoWs – DUR (Medicaid) • ?? Patient – Assist in Clinical Intervention • Registries, Reminders • Practice – Select Collaborators for Improvement Work – Performance Feedback • ??? CSA • Year – Run Charts 24 Contact Info Edward Westrick, MD, PhD MagnaCare HSI, Inc. ewestrick@pol.net 401-475-3734 www.scriptproject.org 25