EQuIPP is a performance information management tool that provides standardized, benchmarked performance information needed to shape strategies and guide medication-related performance improvement efforts.
What do these numbers mean?
Scores represent the percentage of patients that are meeting the intent of the measure. Therefore, for adherence measures, scores represent the percentage of patients at the pharmacy or across the pharmacy organization that are adherent.
Performance measures hosted within the EQuIPP are calculated using prescription drug claims data that has been adjudicated to a health plan or pharmacy benefit manager that partners with EQuIPP.
As an example of adherence, if you see Cholesterol PDC with 100 patients and a score of 92%, then that means of the 100 patients attributed to your pharmacy for the measure, 92% of them have an adherence rate greater than or equal to 80% for the time period that we’re looking at.
Why do we have 3 different measurement periods (seen as “View As” in EQuIPP) and which should I focus on?
Users can select from a “6-Month”, “Year-To-Date”, or “Immunization” measurement period.
The 6-Month measurement represents a rolling period to provide a consistent window to assess performance and determine how activities or new strategies for improvement are impacting scores. The longer the measurement period, the longer it takes to pick up on changes in performance. This is why EQuIPP defaults to display this measurement period on log-in.
The “Year-To-Date” (YTD) measurement period assesses performance throughout the calendar year with the beginning of the measurement period starting on January 1st. The first YTD period calculated in EQuIPP occurs in May of each year and represents data from January through March. In June, the YTD period would display data from January to April. This continues throughout the year until February of the following year when the measurement represents a full calendar year.
The third measurement period known as “Immunization” only applies to the Annual Influenza Vaccination Rate measure to account for the “flu season” which does not fit into either the 6-Month or YTD measurement periods. The “Immunization” measurement period is August 1st through March 31st of the following year.
Users should view performance according the measurement periods that align with either the pharmacy or organization’s strategic approach or performance-based programs that the pharmacy or organization may be participating in. However, most health plans and performance programs are focused on YTD performance.
Where does the data come from?
PQS receives prescription claims and member eligibility details from health plans and PBMs. Therefore, claims that are not adjudicated through the patient’s insurance are not captured.
When are my scores updated?
Scores are updated monthly - typically on the 15th of each month.
Is the data displayed in real-time?
The data and scores are updated monthly. For example, a performance refresh that takes place in August, health plans and PBMs submit data in July which represents data from January through June. PQS validates the submissions and calculates performance which is updated in August.
Compared to other segments and providers within health care such as physicians and hospitals, scoring may have a delay of months or years. EQuIPP exceeds industry standards by having data represented with a 45 day lag time.
What are patient outliers?
Outliers are patients who are not meeting the intent of the measure (e.g. not adherent) and represent targets for improvement.
What is the benefit of documenting my patient outliers in EQuIPP and will I see my score change?
The act of documenting actions, barriers, and outcomes associated with outliers does not change performance scores. Outlier documentation is an available option for pharmacies to keep efforts organized among various staff members that may be acting upon the patient improvement opportunities.
How can my pharmacy use this information?
Information should be used to help formulate a strategy around patient engagement and quality improvement and track how the approach or strategy may be impacting scores.
Yes, EQuIPP is different than an MTM platform. MTM platforms present specific tasks and services that are available for compensation, often through an insurer, such as Comprehensive Medication Reviews (CMRs) and gaps in therapy. EQuIPP tracks pharmacy or organization-level performance on medication-related quality measures. Quality measure performance is assessed across specific areas, such as medication adherence, and may be impacted by certain activities suggested or promoted through the MTM platform at the pharmacy level.
As an illustrative example, EQuIPP can be looked at as the report card for a pharmacy. MTM platforms make assignments available to pharmacies. Like a student, a pharmacy may complete assignments, but it doesn’t mean they are guaranteed to receive a good grade.
If I complete MTM services, does that improve my score?
Not necessarily. You may have a patient that is listed on a MTM platform as needing either a CMR or an adherence item listed. In this situation, you may be able to impact the patient in the MTM platform as well as impacting their adherence score in EQuIPP. You may also have patients showing up in a MTM platform that are not currently negatively impacting your score. It all depends on the situation.