(1154) Leveraging a Collaborative Practice Agreement to Enhance Medicare Advantage Quality Measures

Objectives: TO DESCRIBE THE USE OF A COLLABORATIVE DRUG THERAPY MANAGEMENT (CDTM) AGREEMENT FOR CLOSING, Medicare Advantage PART D (MA-PD) Statin Use in Persons with Diabetes (SUPD) GAPS IN CARE (GIC).
Connecticut recently expanded CDTM legislation. This allows qualified pharmacists to develop CDTM agreements that focus on population health outcomes. PHARMACISTS CAN NOW MANAGE POPULATIONS OF PATIENTS AND COLLABORATE WITH GROUPS OF PROVIDERS USING ONE CDTM AGREEMENT. FOR EXAMPLE, Hartford HealthCare MEDICAL GROUP is using a CDTM AGREEMENT to focus on improving the Medicare Advantage Star measure FOR SUPD. IN THIS AGREEMENT PHARMACISTS ARE INITIATING STATINS FOR MEDICAL GROUP PROVIDERS THROUGHOUT CONNECTICUT. THIS PAPER WILL DESCRIBE THE CDTM PROTOCOL AND STRATEGIES TO CLOSE OPEN SUPD GIC.

Methods:

Design: Prospective quality improvement intervention

Setting, Patients/Participants: MA-PD individuals receiving care within Hartford HealthCare MEDICAL GROUP's clinically integrated network, ages 40 to 75 years with ≥2 prescription claims on different dates of service for any diabetes medication during the measurement year.

Data Collection: Electronic medical records (EMR) and insurance claims data were used to identify POTENTIAL individuals meeting the criteria for the SUPD measure.

Statin use by prescriber and practice location was analyzed to determine trends. Practice locations with the highest open GICS (MEANING NO STATIN USE), and low closure rates were targeted for pharmacist interventionS, WHICH included academic detailing to prescribers, AND SHARING LISTS OF OPEN GICs to PROVIDERS. PROVIDERS WERE GIVEN AN OPPORTUNITY TO EXCLUDE ANY PATIENTS.

BEFORE TELEPHONIC OUTREACH, PATIENTS WITH OPEN GICS WERE INDIVIDUALLY SCREENED BY PHARMACISTS TO CONFIRM ELIGIBILITY OR EXCLUSION CRITERIA AND ACTIONABILITY. FOR ACTIONABLE, ELIGIBLE PATIENTS, A NOTE DETAILING THE PURPOSE OF THE SUPD QUALITY MEASURE WAS ENTERED INTO THEIR CHART. IF PATIENTS WERE ACTIVELY USING EPIC MYCHART MESSAGING, A NOTE WAS LEFT FOR THE PATIENT ADVISING THEM TO EXPECT A CALL FROM A PHARMACIST. FOR PATIENTS WITH EXCLUSION CRITERIA, A NOTE WAS LEFT FOR THE PROVIDER DETAILING HOW TO ENTER APPROPRIATE EXCLUSION CODES.

PHARMACISTS THEN CONTACTED ACTIONABLE PATIENTS BY PHONE. USING A SCRIPT, THE PHARMACISTS WOULD THEN ENGAGE PATIENTS IN A DISCUSSION ON THE RISKS/BENEFITS OF STARTING A STATIN. IF THE PATIENT AGREED TO A STATIN, THE PHARMACIST INITIATED THE ORDER. THE CDTM PROTOCOL SPECIFIED PATIENT FOLLOW-UP TIMELINES AND A STATIN INITIATION NOTE DOCUMENTED IN THE EMR.

Results: IN MEASUREMENT YEAR 2023, a total of 4,786 individuals CARED FOR BY 235 PROVIDERS, were INITIALLY IDENTIFIED BY PAYER/EMR DATA AS INCLUDED IN THE SUPD QUALITY MEASURE. Of these individuals, 798 PATIENTS (17%) were identified AS HAVING POTENTIALLY ELIGIBLE open GICS.

Provider GICs ranged from 1 to 13 open gaps (AVERAGE 2.6), while provider closure rates ranged from 14.3% to 98% (AVERAGE 82.6%). The top 20% of practices (N=30 LOCATIONS) with open GICs REPRESENTED APPROXIMATELY 40% OF THE 798 PATIENT POPULATION.

PRIOR TO INITIATING THE CDTM PROTOCOL, TWO MA-PD PLANS WERE RATED AT 2-STARS. WITHIN 2 MONTHS THOSE PLANS HAD ACHIEVED A 4-STAR RATING. THE STARS INCREASE IS DIRECTLY CORRELATED WITH THE PHARMACIST’S INITIATION OF STATINS, AND BETTER CODING OF EXCLUSION CRITERIA AS DIRECTED BY THE PHARMACISTS.

Conclusions: Connecticut’s legislation expanding pharmacist’s CDTM agreements is having tangible benefits. This SUPD CDTM program highlights how using a combination of clinical and payer data, pharmacists can improve MA-PD Star ratings by directly initiating statins in ACTIONABLE patients. PHARMACIST EDUCATION ON APPROPRIATE EXCLUSION CODING ALSO HELPS REMOVE NON-ELIGIBLE MEMBERS FROM THE QUALITY MEASURE DENOMINATOR. OVERALL, PHARMACISTS USING THIS CDTM PROTOCOL HAVE HELPED IDENTIFY BARRIERS TO STATIN INITIATION, REDUCED PRESCRIBER WORKLOAD, AND IMPROVED MA-PD SUPD STAR RATINGS.