Primary care providers PCPs and pharmacists are at increasing risk for performance under value-based and alternative payment models which rely quality measurement to inform remuneration. Many quality measures used to evaluate PCP performance are medication-related and have potential for pharmacist impact. Little research has evaluated the relative contributions of PCPs and pharmacists to medication-related quality measures. The objective of this study is to estimate relative contributions of PCPs and pharmacists to variations in healthcare resource use, total costs of care, and select medication-related quality measures using a novel statistical tool, the residual intraclass correlation coefficient. Qualiy measures will be selected from the Merit-Based Incentive Payment System measure set as well as PQA-endorsed measures.We will conduct analyses using a Medicare 20% sample from 2011 2014, currently located at the University of North Carolina UNC Gillings School of Public Health Sheps Center for Health Services Research. These data were purchased for unrelated projects and are available for reuse at limited cost to UNC researchers. The datasets contain Parts A and B claims data and Part D event data for over 3 million Medicare lives annually. This proposed research fits well with the Community Pharmacy Foundations mission to assist community pharmacy by providing the resources to encourage new capabilities and continuous improvements in the delivery of patient care. A common problem community pharmacies face in negotiating with PCP offices on value-based contracts is determining the share of risks and rewards pharmacies should bear or receive. If there is found to be a substantial relative contribution of pharmacists to shared quality measures, results could be used to inform a risk sharing amount for pharmacy negotiations. For example, using this methodology, it may be determined that community pharmacists have a 15% impact on attributed patients medication adherence compared to 10% from PCPs. Therefore, the total share of variation would equal the sum of both PCP and pharmacist impact 25% with 60% :15% div by 25%: of the impact attributable to the pharmacist. Thus, in the context of a PCP-community pharmacist value-based contract, the pharmacist could use 60% as a starting point for negotiating shared risk and rewards.
UNC Eshelman School of Pharmacy