New Medicare Prescription Drug Benefit: Opportunities for Quality Improvement Practical Implications

1. New Medicare Prescription Drug Benefit: Opportunities for Quality Improvement & Practical Implications Michael S. Barr, MD, MBA, FACPVice President, Practice Advocacy & ImprovementAmerican College of PhysiciansWashington, DCmbarr@acponline.org202-261-4531

2. Potential for Enhancing Quality, But… Positive Aspects Better coverage for Rx Increased compliance with medication Data analysis re: use, compliance, adverse effects, drug interactions, cost E-prescribing Performance measurement Issues to Resolve Gaps in coverage Compliance-deficit during gap in coverage Delays in data analysis, reporting limit usefulness in practice and quality impact Limits of IT infrastructure Lack of unified measures and stakeholder input

3. Practice Implications Typical internist with 2000 patients in panel: 40% covered by Medicare 800 patients Estimate that 14% dually eligible (range 9-29%) 114 patients 30-40% penetration of remaining Medicare patients 240 patients (using estimate of 35%) Total # of patients in Part D = 350+ Estimated average number of plans/region = 15-20 plans with multiple options + 5 MA-PDP plans

4. Practice Implications (continued) Multiple plans, formularies, policies for appeals… Dually-eligible patients auto-enrolled Potential mismatch of current prescriptions with formulary of PDP Fewer appeals rights No requirement to continue providing medication during appeal Transition plan procedures not fully defined by MMA; variable processes may cause confusion

5. Potential Patient Care Issues Confusion on benefits may cause inaction Transition to formulary medication in elderly may cause medication errors or transient care degradation Potential for drop in compliance during $2850 coverage gap Complicates physician management of care Need to monitor for quality impact

6. E-prescribing Significant potential for improved care Integration with EMRs, practice management systems, and flow of practice essential to achieve intended benefits Cost and lack of information technology infrastructure could limit applicability Need all regional formularies embedded in e-prescribing module Should incorporate clinical decision support

7. Development of Appropriate Measures Measures selected should be selected and agreed upon by multiple stakeholders Example: Ambulatory Care Quality Alliance 26 “starter set” measures for ambulatory care Measures selected and expanded based on principles adopted by alliance Measures should have value to the patient, physicians, the industry and provide insights to further improvement of the program Include medical society representation

8. Summary Significant potential to enhance quality…with caveats Consumers/patients will need significant coaching Physician office implications could be problematic Measurements should be chosen with broad stakeholder input