Pharmacy Quality Solutions Announces Quality Rating System Services for Health Plans Operating in the Insurance Marketplace

DURHAM, N.C., May 22, 2014 /PRNewswire/ -- The CMS Marketplace Quality Team announced on Monday, May 19, the final 2015 Quality Rating System (QRS) Beta Test Measure set. This set of measures will apply to the Qualified Health Plans (QHPs) offered in the Marketplaces in 2014, and includes measures of medication adherence for patients using Renin Angiotensin System (RAS) Antagonists, Non-Insulin Diabetes Medications, and Statins.

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QHP issuers that offer coverage during the 2014 coverage year will be required to participate in the beta test of the Quality Rating System in 2015. These QHPs will need to report the adherence measures using the standard Proportion of Days Covered (PDC) method separately for the three drug categories. The PDC adherence measures are the same as those currently included in the Medicare Part D Star Ratings.

Additionally, in the Final Rule of the Exchange and Insurance Market Standards released on Friday, May 16^th, CMS states that all QHPs will be required to validate their data in a manner that meets HHS specifications prior to submission. The beta test period in 2015 will provide the QHPs the opportunity to review QRS performance prior to these scores being reported to the public and consumers during open enrollment period in 2016 for the 2017 coverage year. QHPs will need to ensure and provide documentation that their data is validated prior to each submission of their QRS data.

Pharmacy Quality Solutions, Inc. (PQS), through their EQuIPP^™ platform, has experience in calculating these measures for health plans using the PDC method. EQuIPP^™ is currently used by many health plans to track their Part D star measures (including PDC rates) in almost real-time, benchmark against other health plans, and evaluate their pharmacy network performance.  EQuIPP^™ also enables the distribution of pharmacy-level performance information to the pharmacy network to support quality improvement. "PQS is excited to develop data validation tools for QHPs as well as offer performance benchmarking to these plans.  We will leverage our experience in supporting performance analysis and benchmarking of the adherence measures used in the CMS Star Ratings to provide these services," says PQS President David Nau, PhD, RPh, CPHQ, FAPhA.  "By providing access to objective data to both pharmacies and QHPs in a standard dashboard, pharmacies and QHPs can work rapidly toward quality improvement."

Additional details on the 2015 QRS Beta Test Measures, certification requirements, and timeline for validation will be released over the next several months. For more information regarding PQS and EQuIPP™ please visit www.pharmacyquality.com or email [email protected].

About Pharmacy Quality Solutions

Pharmacy Quality Solutions (PQS) is a joint venture of the Pharmacy Quality Alliance and CECity. Its primary service, EQuIPP™, is a performance information management platform that makes unbiased quality-related data available to health plans and community pharmacy organizations. EQuIPP™ brings standardization to the measurement of the quality of medication use and makes this information accessible and easy to understand.

Contact:
David Nau, PhD, RPh, CPHQ
President
Pharmacy Quality Solutions
859-537-8462

SOURCE Pharmacy Quality Solutions