Medicare Quality Improvement Organizations' Ambulatory Drug Therapy Improvement Activities and Partnerships With Medicare Part D Prescription Drug Plans and Medicare Advantage Plans

BACKGROUND: The Medicare Modernization Act (MMA) has provided an opportunity for quality improvement organizations (QIOs) to partner with Medicare Part D plan sponsors. These new relationships have developed into a set of diverse projects, each approved by the Centers for Medicare Medicaid Services. OBJECTIVES: To provide information about the scope of the projects being conducted by the QIOs and their partners. SUMMARY: The document describes a variety of quality improvement projects addressing medication use by beneficiaries enrolled in Medicare Part D.Private Medicare QIO contractors are implementing these projects in each state. Descriptions of each project were developed by individual QIOs with the assistance of lead staff for the Physician Practice/Pharmacy QIO SupportCenter for all QIOs nationwide. These projects vary in their complexity, in the quality measures used, and in the clinical processes and economic impact they seek to improve. The summaries in this supplement were prepared 6 months into the current 3-year contract period, which began August 2006. Accordingly, the summaries reflect varying stages of development, funding reductions could occur that necessitate project redesign, and projects have not yet been evaluated. With few exceptions, these projects are not designed as research but as quality improvement projects following the “Plan, Do, Study, Act” model for speeding acceptance of evidence-based practice. CONCLUSIONS: This survey describes the promise of partnerships whose value will be fully realized in future years. The results of these early QIO initiatives will not be available until projects are evaluated, but QIOs and many Medicare Part D plans have established promising partnerships and have begun to share data for the purpose of assessing and improving plan and practitioner performance as well as patient engagement.Most projects are focused on ambulatory care, but some QIOs are addressing nursing home care and continuity of care between settings.Most ambulatory care projects are limited to prescription drug claims data,but a few plans are providing medical and lab data to QIOs in addition to drug claims. QIOs have historically worked almost exclusively with physicians and nurses but in many states are now engaged with colleges of pharmacy as well as with managed care and community pharmacists. QIO partnerships will provide managed care organizations and pharmacists with the opportunity for innovative quality improvement initiatives that might not otherwise be possible because of limitations of available data or resources.Pharmacists can use this document to review a wide array of options for working with QIOs and other partners in their market to design or strengthen their organization's medication therapy management and quality improvement programs. Managed care pharmacists may be particularly interested in the ability of QIOs to assist them in comparing their plans' performance with other national and regional plans.