Implementing a Pharmacist Collaborative Practice Agreement to Improve a Medicare Quality Measure: Statin Use in Persons with Diabetes.

Abstract

Background: Statin Use in Persons with Diabetes (SUPD) is a Centers for Medicare and Medicaid Services (CMS) star quality measure used in Medicare Part D. This measure assesses the Part D plans' success in prescribing statins to individuals with diabetes between the age of 40 - 75 years. This paper illustrates how pharmacists can improve SUPD star ratings by using a collaborative drug therapy management (CDTM) agreement to initiate statin therapy.

Methods: In 2023, pharmacists in a clinically integrated delivery network implemented a CDTM for closing SUPD gaps in care (GIC). Utilizing payer claims data, the pharmacists analyzed multiple years of SUPD results. Open GIC were categorized by practice location, provider, and measurement year. Results were stratified into providers with lower SUPD closure rates (less than 80%) and higher open GIC. Practice locations with the highest number of GIC were prioritized for the pharmacist intervention.

Results: By close of member year 2022, 7,529 individuals were identified as SUPD eligible individuals from within the employed medical group. Of the 7,529 patients, 85.4% were prescribed a statin, leaving 1,098 individuals, cared for by 277 providers with open GICs. There were 76 practice locations showing a range of 5 to 48 open GICs. Provider open GIC ranged from 1 to 13 (mean 2.57). By the end of measurement year 2023, pharmacists increased SUPD star ratings from 2 to 4 stars with two payers and from 2 to 3 stars with one payer.

Conclusion: Expanded CDTM law enables qualified pharmacists to play a pivotal role in influencing population health outcomes. With a CDTM agreement, pharmacists can overcome barriers to initiating statins for eligible individuals and thereby directly impact star ratings.