SCIENTIFIC
Clinical Impact of a Pharmacist Collaborative Practice Agreement on Centers for Medicare and Medicaid Services Quality Measures for Diabetes
AUTHORS: Miller et al
CORRESPONDING AUTHOR:
Julia Miller, PharmD, BCACP, CTTS Email: julia. miller5 @ wvumedicine. org
DISCLOSURES: None
ETHICS STATEMENT:
This study was reviewed and approved by the Institutional Review Board of West Virginia University School of Medicine under protocol number 2411066500.
FUNDING: None
INTRODUCTION
As healthcare continues to evolve, so do reimbursement models. More recently, the United States has seen a shift from feefor-service models that focus on volume to value-based care models that focus on quality. 1 Value-based programs emphasize collaborative care to limit care gaps for patients. 2 The goal of these value-based models is to hold providers more accountable for patient outcomes by incentivizing or rewarding healthcare organizations for meeting various quality measures that aim to improve quality, cost, and equity for patients. If these quality measures are not met, healthcare organizations may lose a portion of their payment from payers. 3
Currently, there are limited studies comparing Centers for Medicare & Medicaid Services( CMS) quality measures in physician-only managed patients to patients who were referred to pharmacy via a collaborative practice agreement. A retrospective study looking at patients from 2017 to 2018 found that the cohort of patients seen by a pharmacist had a greater proportion of patients achieving quality measures compared to a non-pharmacist cohort. 4 Specifically, they found the greatest impact was observed for influenza vaccina-
ABSTRACT
INTRODUCTION
As healthcare evolves from fee-for-service to value-based care models, there is an increasing emphasis on quality over volume. In these models, pharmacists can play a vital role in ensuring patients meet quality measures for health system reimbursement.
METHODS
A retrospective, single-center cohort study was conducted at our university-based internal medical group practice. Patients who did not meet the quality measure for hemoglobin A1c( HbA1c) < 9 % in 2023 and / or those who had a HbA1c > 9 % from January to June 2024 were included in this study. The primary outcome was the percentage of patients meeting the quality measure of HbA1c < 9 % by December 31, 2024. Key secondary outcomes included the percentage of patients completing diabetic eye examinations and kidney health evaluations.
RESULTS
A total of 125 patients were included in this study, 31 in the pharmacist intervention group
tion, hemoglobin A1c( HbA1c) control less than 9 %, and colorectal cancer screening. 4 Notably, in relation to HbA1c, there was a 2023 study that analyzed the impact of pharmacists on the triple-weighted Star measure: C11: Diabetes Care – Blood Sugar Controlled. 5 This study was prospective in which pharmacists intervened on 111 patients who had a HbA1c of > 9 %, and intervention led to 60 of these patients meeting the quality measure of HbA1c < 9 %. 5 This result highlights one of many quality measures pharmacists can impact, which can greatly benefit the health system financially.
The West Virginia University Hospitals( WVUH) Medical Group Practice( MGP) is a large primary care group in Morgantown, West Virginia, operating across two physical clinic locations. The practice is supported by two full-time pharmacists, each assigned to a separate site. Patients at WVUH MGP can be referred to a pharmacist by a provider and 94 in the physician-only group. Baseline characteristics were balanced amongst both groups. For the primary outcome, 61.3 % of patients in the pharmacist intervention group achieved a HbA1c of < 9 % compared to 69.1 % in the physician-only group( P = 0.51). Patients followed by pharmacy were more likely to complete diabetic eye examinations and kidney health evaluations.
DISCUSSION
These findings suggest that pharmacists play a key role in improving access to quality care in the Appalachian region while also supporting health system reimbursement.
CONCLUSION
Based on limited data, pharmacists are just as likely to meet health quality measures for diabetes as physicians with higher likelihood in some categories.
through an electronic health record( EHR) referral for any of nine different chronic disease states. This process allows pharmacists to work in conjunction with physicians to order specific medications and laboratory studies outlined in a collaborative practice agreement( CPA). Any patient can be referred to a pharmacist at the discretion of their primary care provider, regardless of insurance type. Once the referral is placed, the WVUH MGP scheduling team will reach out to schedule an initial pharmacy appointment. After the initial appointment, the pharmacist will schedule subsequent follow-up appointments with the patients as necessary based on clinical judgment. Patients are most often referred to a pharmacist for diabetes management, which has a number of associated CMS quality measures associated. Separate from the pharmacy CPA, WVUH has a population health team of pharmacists, nurses, and social workers that cover multiple locations and are therefore not always face-to-
12 • www. wvsma. org