This month, the EQuIPP platform that pharmacies and pharmacists use to determine how well they are performing added a new measure. The measure is entitled UHC 90-day Fill Rate. The an example of the measure and is shown below.
This measure is only displayed by EQuIPP when viewing Goal: Full Measure Set. This is not a CMS measure; it is what is referred to as a display measure or health plan custom metric. Medicare is not using this measure as a measure of plan success–it is an example of a plan creating a measure that it is interested in improving. In fact, it relates directly to the 90-day performance program I wrote about the blog post entitled Is There Anything Special About the 90-Day supply?
The report above is for one of my pharmacies. It appears that I am not meeting the expectations of the plan, with a current score of 50% and their goal of 70%. But in order to really understand the measure, one needs to know what it really means, and how it is being calculated. According to a source at PQS,
This measure tracks the percent of qualifying patients who were last dispensed an extended day supply ( > 60 days). This will focus on the same medications that are included in the PDC adherence metrics for UHC Medicare Advantage.
As I described in my previous 90-day blog post, plans like UnitedHealthcare are looking to improve their compliance (Percentage of Days Covered or PDC) based measures by incentivizing the 90 day supply. But the measure does not actually take compliance into account. The measure is based at the patient level and is calculated as:
Patients with at least one qualifying PDC drug receiving greater than 59-day supplies
the total number of plan patients qualifying for a PDC measure
I should note that a patient needs to qualify for the PDC measure in order to be included. There is a minimum number of fills required during the 6 month period before the patient is included in a PDC measure.
Going back to the PDC basis of this measure, it would be interesting to see how the qualifying patients are doing with respect to compliance without respect to 90 day supplies. Looking at the UHC 90-Day Fill Rate measure details (within EQuIPP), we see:
The details above show 22 total patients reported. The MAPD patients (listed above under Quality Improvement Programs) are a good place to start, because these same patients are broken out by plan in the individual PDC based measures for each PDC drug category. Below are the overall PDC specific details for each drug category.
Looking at the UnitedHealthcare MAPD lines, the total number of patients totals 14, matching the UHC 90-Day Fill Measure. The other feature that stands out is that all 14 patients (100%) are compliant over the last 6 months over every PDC category.
So despite having perfect (>80% PDC) compliance, my UHC measure reads 50% only because my patients prefer to receive their medications in increments of less than 60 days. Our excellent performance on all of the PDC measures is due, in large part, to the high level of engagement we have with our patients, and this engagement is driven primarily by the 30 day fill cycle. Note that there is no penalty associated with not meeting the UHC 90-Day Fill measure. UnitedHealthcare does, however, reward pharmacies for converting a patient to 90-day fills. Participating in this program, however, only decreases the frequency of the opportunities we have to engage with the patient and impact PDC.
This brings us back to the plan’s decision to create the UHC 90-Day measure and reward pharmacy conversions to 90 day supplies. CMS provides incentives to MAPDs if their network pharmacies perform well on the the CMS Threshold measures. If the impetus of UnitedHealthcare’s 90-day measure is to improve PDC measures, then why don’t they simply use the CMS PDC measures already in place? Why create a new, plan specific, measure which is only loosely correlated to the desired outcome? The only explanation I can muster is that, perhaps, improved PDC is not the plan’s actual goal. It would be nice if UnitedHealthcare more clearly communicated its goals to the pharmacies that are providing patient care.
Each pharmacy will have to decide if they wish to take UnitedHealthcare up on its offer to reward them for these conversions. For us, however, losing opportunities to interact with the patient is not worth it. We will continue to make every encounter count.
