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Payers drive quality care with NQF measures

Publish date: MAR 01, 2011


Judy Y. Chen, MD, MSHS
Payers are challenged to change the way patients are managed. Effecting change requires that standards of care are not only implemented, but measured and managed from patient and provider perspectives.

To improve the quality and safety of medication use, the National Quality Forum (NQF) has endorsed measures that cover a variety of chronic conditions such as diabetes, high blood pressure and psychiatric disorders. These measures assess whether patients have appropriate medication prescribed to treat the disease, receive a sufficient supply of medications in order to follow the treatment, have their medication reviewed annually, have their medication reviewed when discharged from the hospital, and receive appropriate monitoring.

NEW MEASURES DRIVE CARE

Among medication-related measures endorsed by NQF are:
Antipsychotic use and adherence among schizophrenic patients. Schizophrenia is most often first encountered in young adulthood and is placed among the top contributors to the global burden of disease. Antipsychotic medications remain the cornerstone of treatment and can substantially reduce the risk of relapse (less than 30% per year). Without maintenance on antipsychotics, 60% to 70% of patients relapse within one year, and 90% relapse within two years.

The intent of this measure is to ensure that patients diagnosed with schizophrenia were prescribed the appropriate medications and have received a sufficient supply of medications in order to follow the treatment as prescribed by their physicians. Compliance for this measure in 2007 ranged from 52% to 80% across health plans, representing an opportunity to measure adherence and manage patients to ensure the best outcomes possible.

ACE inhibitors/Angiotensin-receptor blockers (ARBs) use and persistence among coronary artery disease patients. Several large, randomized, control trials have found that high-risk patients with coronary artery disease who received ACE inhibitors (ACEIs) have significantly lower risk of heart attack or stroke.

The intent of this measure is to ensure that patients with high-risk coronary artery disease are appropriately managed, and are given ACEI/ARB medication, including assurance that the patients have received a sufficient supply of medications. Compliance for this measure in 2007 ranged from 32% to 65% across health plans.

Adherence of lipid-lowering medication. More than 50 million U.S. adults have blood cholesterol levels high enough to require medical advice and treatment. Poor adherence to drug therapy remains a major therapeutic challenge. On average, patients who are prescribed lipid-lowering drugs do not fill their prescriptions for over one-third of the year. Only half of patients continue to take lipid-lowering drugs six months after they are given a prescription, and only 30% to 40% of patients continue to take them after 12 months.

The clinical intent of this measure is to ensure patients who are taking medications to treat hyperlipidemia filled sufficient medication to have at least 80% coverage during the measurement year. Compliance for this measure among health plans ranges from 58% to 75%.

By measuring quality and safety of medication use, payers can directly impact the quality of care, reduce total healthcare costs and improve the quality of life for their members.

Judy Y. Chen, MD, MSHS, is the director, research and clinical development for the payer solutions business line at IMS Health.

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