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EQUIPP® FAQ

Please see below for our list of frequently asked questions!

  1. EQUIPP® Overview
  2. Performance Dashboard/ My Programs
  3. Patient Safety, Immunizations, & Pharmacy Measures
  4. Outliers

 

EQUIPP® Overview Questions

  1. What is EQUIPP®?
    • EQUIPP® is a performance information management tool that provides standardized, benchmarked performance information needed to shape strategies and guide medication-related performance improvement efforts.

    • New to EQUIPP or need a refresher? Click the link below to join one of our weekly platform demos:

      Join Weekly Platform Demo

       

  2. Who is PQS?
    • Pharmacy Quality Solutions (PQS), is the leading provider of performance management services between payers and providers so patients and members can receive the highest quality of care. PQS delivers the quality insights and guidance necessary to support its customers' efforts to optimize the quality of medication management and use for their Medicare, Medicaid, and commercial populations. PQS connects medication-use stakeholders to actionable, quality information consistently and reliably, allowing them to move more quickly from measurement to improvement. Its industry-leading platform, EQUIPP®, provides consistent and reliable measurement and reporting on key medication use quality measures, including addressing medication adherence, gaps in care, and patient safety. 
  3. 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 (i.e. Cash or Discount Card).
    • PQS has created a downloadable PDF that visually shows the process of how pharmacy data is transmitted and received and reviews sample 6-month and year-to-date timelines. Click to download.
  4. How can my pharmacy use this information?
    • The performance tracked in EQUIPP® is specific to how the payer views your performance and aligns with the payer’s accountability to Medicare (Star Ratings) and other quality programs
    • 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.
    • Steps to better utilize EQUIPP®
  1. Is there EQUIPP® training available?
  1. When are my scores updated?
    • 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.
  2. Where is my Star Rating in EQUIPP®?
    • Pharmacies do not receive Star Ratings; however, you do have performance scores based on measures that do impact the Star Ratings that Health Plans receive. Our dashboard provides an aggregated view of how you are performing for each measure based on the health plans/PBMs that provide us with claims data.

 

Performance Dashboard and My Programs

  1. What is the performance score?
    • The performance scores represent the percentage of patients who 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 who are adherent. Performance measures hosted within EQUIPP® are calculated using claims data that has been adjudicated to a health plan or pharmacy benefit manager that partners with EQUIPP®.
  2. How are the "goals" determined for each performance measure?
    • Users can select a goal set from the list in the drop-down menu in the upper left-hand corner of the dashboard. These thresholds are updated as the Centers for Medicare & Medicaid (CMS) update their information. A Default goal set is also available, which is typically based on the Medicare Star Ratings 5-star threshold. EQUIPP® populates goals based on past performance for measures not in the Medicare Star Ratings program. 
    • The Top 20% goal shows the percentage needed to be among the top performers across EQUIPP®. This is determined by evaluating the performance score of more than 60,000 pharmacies that have at least ten (10) patients for the measure during the measurement period. It is updated every month along with the latest EQUIPP® refresh. The Top 20% goal is typically higher than the CMS 5-Star goal and the highest program goal found in EQUIPP®'s QIP Table. You may notice two different Top 20% goals in the goal set drop-down, 6-month and year-to-date (YTD). The Top 20% goals differ between the 6-month trend and YTD because a different set of data is being used.
  3. What are the Organization and State Averages?
    • This section is a comparison of information to other pharmacies in your organization, state, and the average for all pharmacies in EQUIPP® for this specific metric
  4. What is the Measure Performance page?
    • The Measure Performance page can be found after clicking on any measure name. This page provides measure details such as benchmarks, run charts, insurance mix, and QIP details. 
  5. Why do we have 2 different measurement periods and which should I focus on?
    • Users can select from a “6-month”, “Year-To-Date” from the main performance dashboard
    • 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 “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 until February of the following year when the measurement represents a full calendar year.
    • Users should view performance according to 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.
  1. What is the My Programs tab?
    • The ‘My Programs’ tab hosts performance program data for specific health plans that directly correlate patient counts and/or performance scores with financial impact. This level of transparency is intended to help pharmacies understand where there is an opportunity for performance improvement and how that opportunity equates to a potential financial incentive. Each instance of a “My Programs” is implemented when a plan or payer has agreed to provide this level of detail through EQUIPP® for pharmacies

      7. How can I contact EQUIPP Support Directly? 

  • Please reach out to us directly at support@pharmacyquality.com or click the Orange Support Web Widget in the lower right-hand corner of the screen and select the "Get in touch" option. This will submit a ticket and our support team will reach back out directly

Patient Safety, Immunizations, & Pharmacy Measures

  1. What are the types of measures hosted within EQUIPP®?
    • EQUIPP® hosts two primary types of measures:
      • Adherence Measures (Proportion of Days Covered or PDC)
        1. Cholesterol PDC
        2. Diabetes PDC
        3. RASA PDC
      • Treatment/Safety Measures
        1. Statin Use in Persons with Diabetes (SUPD)
        2. Statin Use in Persons with Cardiovascular Disease (SPC)
      • Additional quality measures may be hosted in EQUIPP® for payer-specific programs or as new quality measures are added to existing quality programs
  2. What is a PDC rate?
    • Proportion of Days Covered (PDC) measures assess the percentage of patients covered by prescription claims for the same drug or another drug in the same therapeutic class, within a measurement period. The PDC threshold is the level above which the medication has a reasonable likelihood of achieving the most clinical benefit (at or greater than 80% for most of the measures). The PDC methodology is a standard method used to measure medication adherence and is specified within the adherence measures endorsed by the Pharmacy Quality Alliance.
      • PDC Specialty quality measures that also utilize the PDC methodology are:
        • Antiretroviral PDC
        • Multiple Sclerosis PDC
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     3. What medications are used to calculate the adherence measures?

  • The therapeutic categories are covered by the adherence measures hosted within the EQUIPP® platform:
    • Cholesterol PDC: Statins
    • Diabetes PDC: Non-insulin Diabetes Medications (including biguanides, sulfonylureas, DPP-IV inhibitors, TZDs, GLP-1 receptor agonists/incretin mimetics, meglitinides, and SGLT2 Inhibitors) **Patients on insulin are excluded from this measure**
    • RASA PDC: Renin-Angiotensin System Antagonists (including ACE inhibitors, ARBs, and Direct Renin Inhibitors)

      4. How are patients attributed to a pharmacy?

  • Adherence measures use an encounter-based attribution method. For PDC measures, the pharmacy that filled the most prescription claims within the measurement period for the target therapeutic category will be assigned responsibility for the patient. If a patient fills the same number of prescriptions during the measurement period at multiple pharmacies, the patient will be attributed to the pharmacy that completed the most recent fill. All paid prescription drug claims adjudicated through the health plan, regardless of dispensing pharmacy, will be counted towards the patient's PDC calculation, any fills that are not filled through the health plan, will not be counted toward

      5. How do patients qualify for the adherence measures?

  • The minimum requirements for a patient to be eligible for the adherence measures include:
    • The patient must have at least two (2) fills in the measurement period – regardless of the day supply of the prescription fills or the dispensing pharmacy
    • The first fill of the applicable medication (class) must be at least ninety-one (91) days before the end of the measurement period

     6. What happens when a patient has transferred to a different pharmacy?

  • The patient will be attributed to whichever pharmacy filled the most prescriptions for medication for this specific measure in the performance data date range in EQUIPP®. If a patient has the same number of fills at multiple pharmacies, the pharmacy with the most recent fill will be attributed to the patient. It will typically take a patient a few months to drop off the outlier list of the pharmacy that is not currently filling the medications for that patient anymore.

    7. What happens when a patient has discontinued a medication?

  • For the adherence measures specifically, if a patient has already had eligible fills to qualify for a measure, they will remain attributed during the measurement period. The patient will not be included in the measure once they have less than 2 fills of the medication within the measurement period or qualify for exclusion criteria.

     8. What if a patient pays for their prescription with cash or a discount card?

  • The performance scores are based only on adjudicated claims. The performance tracked within EQUIPP® is specific to how the payer views the pharmacy’s performance. Therefore, prescriptions only processed through discount cards or cash are not included in the measure calculations because the payer does not have any record of the cash or discount card claim happening.

     9. What if a patient is on multiple medications within the same therapeutic category?

  • The 3 adherence measures assess adherence to medications within that class of therapy. The days marked as covered are adjusted when the quantity supplied overlaps for the same target ingredient. This helps to account for patients who fill early. Additionally, coverage by only a single target medication is necessary to fulfill the criteria, which can sometimes work in the pharmacy’s favor for patients who require multiple medications, such as for diabetes.

Outliers

  1. 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.
    • Patient Outlier reports provide a list of patients who are adversely impacting or may adversely impact your quality measure performance now or in the future for measures hosted in the EQUIPP® dashboard. By addressing these patients, you are taking steps to improve patient care and affect your performance rates down the road. PQS calculates outliers in most cases on a monthly basis, however, in some instances the data provider shares the outlier information directly. In such cases, they may be using a more recent time frame to identify patient outliers, therefore, some patient outliers may not reflect the performance data date range being displayed and may be updated daily.
  1. Why do some outliers say “Late Refill”?
    • The outlier type will display as “Late Refill” not “Outlier” as these patients may not yet be outliers. The data provider sharing this data is alerting the pharmacy that the patient was or is late to refill their medication. Late refills may be identified as prescriptions that are anywhere from 11 to 17 days past due.
  1. What are the outlier designations?
    • A feature within the outlier information of the performance dashboard to categorize how that patient is being identified. Patient outliers may include standard outliers, patients late for refills, or patients with a first fill of target medications. The following Outlier Types are displayed:
      • Extended Day Supply Opportunity – The patient has been previously dispensed a 30-day supply but is eligible for a 90-day dispense of the related medication.
      • Low-Income Subsidy (LIS) – The patient is eligible to receive a 90-day supply for the same copay as a 30-day supply
      • No Impact – The patient does not have the potential to become adherent before the end of the calendar year based on their PDC Rate.
      • Actionable Impact – The patient has the potential to become adherent by the end of the current calendar year based on their PDC Rate.

      4. Why are commercial and Medicaid patients listed in the outliers list?

  • The data in EQUIPP® is mostly Medicare at this time but also includes some Medicaid and Commercial insurance programs. You can view the details of the program within the "Analyze Performance" tab for each measure. Within this tab, you should be able to see the insurance type breakdown and the plan level breakdown. For complete information on the outliers that each managed care organization provides review the program details for each program in the "Quality Improvement Programs" table. This should provide specific information including which outliers the organization provides and any additional designations.

       5. What is the outlier documentation? Does completing the documentation impact the performance scores?

  • Outlier documentation is an available option for pharmacies to keep efforts organized among various staff members who may be acting upon patient improvement opportunities. The act of documenting actions, barriers, and outcomes associated with outliers does not change performance scores. When a patient is adherent, the documentation status will say "Not Applicable."

       6. How can I remove an outlier that has deceased?

  • According to the measurement specifications, patients will be evaluated through the end of the measurement period, the member’s exact death date (if applicable), or the end of their enrollment with the plan.
    • PQS receives monthly eligibility files from participating health plans and reconciles member eligibility with the measure calculation. Based upon when the health plan records are updated with this information, it may not be immediately reflected for the patient in the dashboard as it depends on how long it takes the health plans to receive the information. The data will be reconciled with the reporting on the date the patient passed once the records have been updated.
    • If a patient passes away, they are no longer evaluated for that measure from that point moving forward. However, the pharmacy and health plan would still be evaluated for the time period in which the patient is alive. Therefore, a pharmacy simply relying on patient outliers may be limiting its capabilities to improve quality measure scores.

      7. How can I remove an outlier that is an outlier due to hospitalization or rehab?

  • Scenarios such as these are limited. When they do occur, a patient may experience a lapse in fills at your pharmacy during their stay.

      8. How can I remove an outlier that went to a nursing home?

  • If a patient has moved to a nursing home and is no longer getting their medications at your pharmacy, once the majority of the fills are at the pharmacy providing the nursing home’s medication, then the patient will no longer be attributed to your pharmacy. Once the patient is attributed to another pharmacy, the patient will no longer be listed in your outlier section for that measure.
  1. When will a patient be removed from the outlier list?
  • A patient will no longer appear on the outlier list if they become adherent, are attributed to another pharmacy, or if they no longer qualify for the measure.
    • This depends on when they had their last fill that was adjudicated to the insurance company. In order to be included in a measure, the patient must have at least 2 fills of a medication billed to insurance in the measurement period/data date range. If they have one fill (or less) in the measurement period, they will not be included in the measure and will not impact your performance scores for adherence at all.

 

 

 

 

 

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