The requirement to measure and report on the quality of the health-care services delivered by providers is growing, alongside the redefined nature of the relationship between payers and health-care providers, such as pharmacy, said Ned Pojskic, leader of pharmacy and health provider relations at Green Shield Canada.
“This system . . . is designed in its very nature to award amazing pharmacists . . . in terms of the clinical services they provide, while perhaps changing the nature of the reimbursement structure for those who don’t do so great,” he said during a session at Benefits Canada‘s 2019 Halifax Benefits Summit on Sept. 24. “Our health-care system in Canada is our pride and joy. We’re the envy of the world in terms of the quality and value of our health-care system. But we do have issues. . . . We’re a mixed picture of health. People are living longer, but many more with chronic diseases and we’re not treating these well.”
The performance of the health-care system is generally quite poor, he said, and there are various issues, not only in chronic disease management but in other areas as well. One thing that’s come up time and again is health-care providers, noted Pojskic. “If you look at the line item in terms of what costs our health-care system the most, it’s health-care providers that are right up there. They’re the No. 1 cost, but also the No. 1 opportunity to change our health-care system by looking at the quality of service delivery of individual providers.”
Underlying this is the notion the health-care system can’t change if it isn’t being measured, and that’s the starting point, he said. “How could you possibly change something if you don’t know your baseline?”
Ontario’s Institute for Clinical Evaluative Sciences measures the performance of physician networks across the province. Some networks are doing a really good job, said Pojskic. “This notion of measuring health-care quality is relatively new in the Canadian landscape. We never thought about this in this particular context before, but it’s not new internationally.”
Pointing to the U.K. and the U.S., he said this is a well-established practice. In the context of provincial governments, it’s gaining traction, with Ontario introducing the Excellent Care for All Act in 2010, which began measuring the performance of hospitals in particular, tying chief executive officer’s compensation to certain quality targets. “The CEO does the right things, the hospital will do the right things — the chain of command goes right up to the top and so does the responsibility. The idea is that hospital performance improves, quality of care improves, outcomes improve. But we have to start at the very top.”
Pojskic also noted that each province has a body in place to measure the performance of its health-care system, with various councils in place to measure performance. “What’s interesting is that, despite the fact that drugs are now the leading way you treat patients, . . . you used to treat patients in hospital. Now drugs are displacing a lot of that. Patients are cared for in the community and yet pharmacists are not part of any of these health-care system measurement tools right now.”
That’s a complete oversight in terms of measuring the performance of pharmacy, he said. “Pharmacy is vital to ensuring patients are getting the right therapy at the right time and improving their outcomes. This is where the notion of value-based pharmacy comes into play. . . . The idea behind it is to measure the performance of pharmacies, all 10,000 of them across the country, on a number of medication-use quality measures.”
These include medication adherence, measuring disease management and a patient safety measure. Together, said Pojskic, they comprise the quality assessment framework. “The idea is we measure every pharmacy on the basis of these eight measures and then we do something with that. The key principles behind this entire initiative is the idea of audit and feedback. We know this works.”
Read more stories from the 2019 Halifax Benefits Summit.