Breakout Sessions  

We will offer pharmacist continuing education for breakout sessions at the 2023 PQA Annual Meeting, which will be jointly provided by Partners for Advancing Clinical Education (PACE) and Pharmacy Quality Alliance (PQA). Learn more about continuing education

Breakout Session I  -  Thursday, May 11, 11:00 a.m. - 11:45 a.m.

Impact of Applying SDOH on Prescription Fill Rate Analysis  
The prescription journey for patients focuses on three main areas, fill rates, abandonment rates, and rejection rates. Traditional analytics focuses only on age, gender, and/or marital status. The integration of medical and pharmacy claims records with Social Determinants of Health (SDOH) sheds new insights into healthcare delivery and disparities. The impact of applying these values changes the way we look at the patient journey.

Learning Objectives
1. Discuss options to prioritize SDOH variables in prescription fill rate analyses for actionability.
2. Identify strategies for SDOH inclusion when assessing medical and pharmacy claims.
3. Explain methods for assessing barriers to patient medication access.

Russell Robbins, Chief Medical Information Officer, PurpleLab

Using Technology to Drive Patient Care
The specialty medication patient journey can be challenging, and costly medications often require a complicated access process. Once initiated on treatment, patients may need to navigate difficult dosing and administration schedules, monitoring requirements, and side effects. The Health-System Specialty Pharmacy (HSSP) model is designed to support patients through every step of the patient journey from ensuring medication access and affordability to monitoring medication administration, effectiveness, adverse effects, and safety. Because managing these medications and coordinating specialty patient care can be challenging, HSSPs could benefit from utilizing technology to ensure patients outcomes are optimized. Access to the electronic health record (EHR) allows HSSPs to harness the tools and information within to inform patient care. Additionally, gathering information from the EHR into dashboards or reports enables HSSPs to move beyond managing patients at specific intervals or when issues arise to proactively identify at risk patients and provide additional support.

This session will highlight quality improvement endeavors by the Vanderbilt Specialty Pharmacy that have harnessed EHR and HealthIT capabilities to identify patients at risk for gaps in treatment or poor outcomes, manage patients receiving medications requiring coordination between medical and pharmacy benefits, and monitor specific patient populations for overall and individual outcomes.

Learning Objectives 
1. List challenges in specialty pharmacy medication management that could lead to increased risk of poor outcomes for patients.
2. Discuss the data available to Health System Specialty Pharmacists that could help identify patients who could benefit from additional support.
3. Describe targeted support that could be provided to patients to lessen their risk for poor outcomes.

Cori Edmonds, Clinical Pharmacist Specialty, Residency Program Director, Vanderbilt Specialty Pharmacy
Miranda Kozlicki, Clinical Pharmacist, Vanderbilt Specialty Pharmacy
Monica Littlejohn, Clinical Pharmacist, Vanderbilt Specialty Pharmacy
Kristen Welchel, Research and Patient Care Improvement Pharmacist, Vanderbilt Specialty Pharmacy

Integrating Pharmacists in Team-Based Care: Opportunity to Improve Health Outcomes 
There is strong evidence that team-based care (TBC) involving pharmacists improves health outcomes, including blood pressure control. Adding pharmacists to the health care team, whether in a community or traditional clinical setting or through telehealth, can be a strategy to increase the availability of cardiovascular disease prevention services. When TBC models, including pharmacists are implemented in settings that serve patients who are medically underserved due to long-standing systemic social and health inequities, opportunities to advance health equity may increase. Despite the evidence for the effectiveness of team-based care, there are barriers that may present a challenge to implementation and expansion, including gaining leadership and clinician buy-in, bi-directional communication between care team members, and navigating relevant policies. The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention promotes evidence-based practice through knowledge translation and the development of practice-based evidence to inform decision making and support the implementation of programs for the prevention and management of heart disease and stroke.

During this session, presenters will discuss considerations and lessons learned from several team-based care models that include pharmacists in different settings and highlight policy-related mechanisms pharmacists may use to provide evidence-based patient care services.

Learning Objectives
1. Describe the role of pharmacists in team-based care and associated evidence in improving health outcomes.
2. Identify practical strategies that can be applied to address the challenges of incorporating pharmacists into team-based care.
3. Describe how policies can be used to leverage pharmacist-provided patient care services.

Katrice Lampley, Pharmacist Consultant, ARST, Inc.
Adebola Popoola, Health Scientist, Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention
Nicole L. Therrien, Pharmacist, Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention

Best Practices in Pharmacist Collaboration with Physicians and Payers to Improve Quality  
Pharmacists have been at the forefront of interprofessional collaboration; nevertheless, they often lack practical information on how these collaborations operate. In this session, the speakers will provide examples of the services that pharmacists engage in to sustain their collaborations. Additionally, they will describe ways in which pharmacists actively engage with payers and physicians to demonstrate their value. Through this session, attendees will gain insights on how to strengthen interprofessional collaborations and improve their engagement with payers and physicians.

Learning Objectives
1. List opportunities for pharmacists to improve care in collaboration with physicians or health plans.
2. Describe how these collaborations benefit patients, physicians, pharmacists and health plans.
3. Discuss example best practices to improve value-based care within these collaborations.

Amina Abubakar, Chief Executive Officer, Avant Pharmacy and Wellness
Josh Young, Co-Founder & Chief Pharmacy Officer, Troy Medicare

Breakout Session II  -  Thursday, May 11, 12:00 p.m. - 12:45 p.m.

Show Me the Data: Collect and Analyze Health Equity Data 
As stakeholders work to address disparities in care, use, and access, many often cite a need for more robust data to understand where inequities exist. Inconsistent and incomplete data on race, ethnicity, sexual orientation/gender identity, and geography can lead to missed opportunities to provide care and improve outcomes. However, there are challenges with collecting complete, appropriate, and accurate data. Health plans have opportunities to collect and augment existing information, evaluate where inequities exist, and undertake interventions.

This session will provide an overview of the current standards, opportunities, and challenges with the collection of race, ethnicity, language, sexual orientation, gender identification, geography, disabilities, and SDOH data. Additionally, case studies will be shared regarding how health plans use this data to implement and improve medication use quality for all members

Learning Objectives
1. Recognize the gaps in medication use due to health disparities and the role health plans can play in bridging the gaps.
2. Identify opportunities and challenges health plan members face when collecting race, ethnicity, language, SOGI, disabilities, geography, and SDOH data.
3. Review case examples on methods to collect health equity data and explore how data can be used to improve medication use quality.


Matthew Din, Senior Director, Pharmacy Quality Care & Experience, SCAN Health Plan
Mason Johnson, Executive Fellow, Academy of Managed Care Pharmacy
Hannah Lee-Brown, Director of Pharmacy Benefits, Healthfirst

Pharmacy and Beyond: Advancing the Quality of Pharmacist-Provided Care by Optimizing Multidisciplinary Strategies 
A patient’s full health care team is comprised of several different health care providers who play a key role in the overall quality of care received by the patient. To that end, it is imperative that a collaborative and multidisciplinary approach is used to observe the greatest impact on quality of care. Quality measures help quantify the quality of health care services provided to an individual or population. Quality measure ratings can be used to identify areas of weakness, drive improvement strategies and ultimately ensure optimal care is delivered to patients. A higher quality rating is associated with a higher quality of care being provided. Pharmacist-provided care can be advanced through collaborative efforts with other members of the healthcare team.

This presentation will review the effect of multidisciplinary approaches on quality ratings and overall quality of care provided to members. The outcomes of multidisciplinary-focused Medication Therapy Management (MTM) programs will also be reviewed.

Learning Objectives
1. Discuss the impact of quality ratings on overall quality of care provided to members.
2. Identify multidisciplinary strategies to address quality measures and positively impact quality of care..
3. List strategies for promoting multidisciplinary approaches to improving quality of care provided..

Courtney McMahon, Clinical Pharmacist Supervisor, PerformRx
Binal Patel, Director of Clinical Outcomes & Therapeutic Optimization, PerformRx

Closing Behavioral Health Measurement Gaps in Medicare Quality Programs 
Improving the quality of behavioral and mental health care is a consistent priority across a range of Health and Human Services and Centers for Medicare & Medicaid Services initiatives, including the Meaningful Measures Initiative, the 2022 Framework for Health Equity, and the Biden Administration's Unity Agenda, as well as CMS' Behavioral Health Strategy. The Medicare Part C and D Star Ratings program is a critical incentive system for assessing the quality of Medicare Advantage plans through publicly released ratings. However, despite CMS' emphasis on this topic, no behavioral or mental health quality measures are used for scoring in the program. Further, due to shortages in behavioral health professionals, especially psychiatrists, including in Medicare Advantage plan networks, the quality of care for these populations may be at risk.

This session will review the availability of measures for assessing the quality of mental and behavioral health screening and prescribing, potential challenges for reporting and performance, and key considerations for their potential future inclusion in Medicare programs. Case studies examining key areas of medication quality, including anti-depressant and antipsychotic medication prescribing and adherence, will be featured.

Learning Objectives
1. Identify behavioral health measurement gaps in Medicare programs.
2. Describe opportunities and challenges associated with behavioral health quality measures.
3. List quality improvement opportunities associated with behavioral health measurement (e.g., screening, adherence).

David Blaisdell, Director, Real Chemistry
Caroline Carney, President, Behavioral Health and Chief Medical Officer, Magellan Health
Samuel Stolpe, Head of Healthcare Quality Strategy, Johnson & Johnson


Overcoming Regulatory Constraints While Delivering Pharmacist-Provided Care and Services 
Pharmacist involvement in team-based healthcare is critical for improving patients' quality of care, thus improving outcomes. Lack of provider status, reimbursement issues, and additional educational requirements often deter many pharmacists from providing patient care services, while value-based models alleviate some barriers but not all. This session offers solutions to overcome those barriers and provides actionable legislation and regulatory suggested changes to increase pharmacist participation in value-based care.

Learning Objectives
1. Identify value-based care pharmacy practice opportunities.
2. Describe Collaborative practice agreements (CPAs), statewide protocols, and standing orders.
3. Discuss opportunities to address current legislative and regulatory constraints related to pharmacist-provided care and services.

Allison Hill, Community Pharmacist, Walgreens
Saba Syed, Senior Director, Clinical Quality Pharmacy, VillageMD


Breakout Session III  -  Thursday, May 11, 2:15 p.m. - 3:00 p.m.

Advancing Health Equity in PBM Programs 
Advancing health equity is one of Humana’s priorities, and this session will review Humana’s enterprise and pharmacy-level approach to address this important issue. Content will include defining health equity and health disparities, reviewing data highlighting disparities among members, pharmacy programs to advance health equity, and lessons learned.

Learning Objectives
1. Define health equity.
2. Outline Humana's health equity strategy and areas PBMs and health plans can influence.
3. Identify lessons learned during the health equity council's effort to imbed health equity awareness and prioritization into the organizational culture.

Rainelle Gaddy, Strategy Advancement Lead, Humana

Medication Adherence: A Force Multiplier for Star Ratings Success 
Rising thresholds will make it harder for MA plans to move the needle to four and five stars, especially those serving high-risk populations with SDOH challenges. The key to success is ensuring year-round medication adherence for all health plan members. Beyond the direct scoring power of three triple-weighted measures, medication adherence drives compounding change throughout the CMS quality framework. It's a force multiplier directly related to many other heavily weighted and influential components of the system, including CAHPS, involuntary attrition, Drug Plan Quality Improvement, and Part C Blood Sugar and Pressure Control measures. In this session, participants will analyze the cascading fruits of medication adherence and how it can jumpstart a cycle of success with Medicare Advantage Star Ratings. Plans that do well on medication-related measures ultimately achieve better ratings. Those that score four or more Stars are eligible for a slice of the nearly $10 billion QBP fund, allowing them to reinvest in member benefits and attract more potential members. Since QBP bonuses are paid on a per member bases, making the leap to 4 Stars increases revenue up to 17.6%, according to recent studies. Learn how plans that engage their highest-risk members and reach medication adherence benchmarks can unlock all the benefits of high performance on the Star Ratings scale.

Learning Objectives
1. Investigate important trends in the 2023 Star Ratings performance data.
2. List all the areas of the Star Ratings framework that medication adherence directly influences.
3. Analyze how medication adherence is the catalyst to improve overall Star Ratings performance and acts as a "force multiplier".
4. Review multidisciplinary, data-driven strategies to drive medication adherence among high-risk populations, improve Star Ratings, and jumpstart a positive feedback loop.

Jason Rose, Chief Executive Officer, AdhereHealth

Deprescribing: How to Ensure that Older Adults Take the Right Amount of Medications. Nothing More, Nothing Less. 
Polypharmacy is not a new or novel concept for clinicians to be mindful of when treating patients. However, its prevalence in the management of chronic conditions in older adults is notable. While clinicians agree that it should be addressed, there often isn't structure built into organizations to allow for meaningful interventions that work to reduce polypharmacy more judiciously. Polypharmacy in older adults often leads to safety issues, unnecessary costs, management burden, and does not allow seniors to live their golden years to their maximum potential. Deprescribing is an active process that is geared towards stopping unnecessary medication and/or reducing doses that pose safety concerns and could cause more harm than benefit. It is an effective strategy for addressing polypharmacy and is relatively straightforward as long as proper attention is given.

This session describes how a leading Medicare health plan implemented and is growing its deprescribing program which is working to better our healthcare system through its pharmacists and partnership with providers

Learning Objectives
1. Review the growing issue of polypharmacy and its impact on older adults.
2. Explain the process of deprescribing and how it is designed to address polypharmacy.
3. Describe how managed care organizations can institute deprescribing initiatives and be enabled to reduce unnecessary medications, particularly for older adults.

Priscilla Franco, Care Management Pharmacist, SCAN Health Plan

One Size Does Not Fit All: Value-Based Pharmacy Payment Models in Practice  
Value-based program payment models can be utilized to drive metrics, meaningful outcomes, and engagement within a value-based program, but what works best? This session will explore real-world examples of multiple payment models and the results delivered. Hear war stories and lessons learned from experienced leaders in the payer and software space to learn what payment models foster the highest pharmacy engagement, improved outcomes & measures, and plan savings.

Learning Objectives
1. Describe the most common value-based pharmacy payment models.
2. Evaluate the input variables needed for drafting value-based pharmacy payments.
3. Recommend differences in measurement criteria based on virtual or live pharmaceutical care.

Maxwell Anderegg, Head of Clinical Programs, DocStation
Justin Bioc, Head of Clinical Pharmacy, Devoted Health

Session IV  - Friday, May 12, 9:15 a.m.-10:00 a.m.

Integrating Clinical Service Initiatives to Improve the Member Journey and Reduce Abrasion
The driving forces in our healthcare system today are hyper-focused on addressing health equity, reducing abrasion, and enhancing patient experience through stronger patient engagement strategies. The stakes are high. Comprehensive medication reviews (CMR) in Medicare are an important component of optimizing medication outcomes, educating patients on their chronic conditions, and not just creating a strong patient experience – but maintaining it over time.

With these goals in mind, Healthfirst brought CMRs “in house” and deployed their own pharmacists to engage with patients, via Alliance by Aspen RxHealth. This model deploys an innovative technology platform with the assurance that over 7,000 pharmacists are at the ready, should the amount of clinical interventions at any time exceed Healthfirst’s  internal capacity.

The combined efforts of these two organizations yielded a reduction in touchpoints,  accurate matching of pharmacists to patients’ unique needs and demographics, and the execution of high-touch interventions that are actively delivering an improved and more measurable member experience. Join us as Healthfirst and Aspen RxHealth discuss how they approach the patient journey by intelligently matching pharmacists to each patient's sociodemographic profile and the measurable goals they are targeting to accurately predict and measure success.

Learning Objectives
1. Identify how mapping clinical interventions leads to an improved patient experience.
2. Discuss strategies for reducing member abrasion in a health plan setting, and the downstream impact they have on the patient experience.
3. Discuss the impact of potential changes to the Medicare MTM Program in 2024 and how organizations should consider approaching this expansion while maintaining a high-touch, high-quality approach to CMR completions.

Kim Russo, Senior Vice President, Pharmacy Services, Aspen RxHealth
Alex Wiggall, Senior Pharmacy Manager, Healthfirst

Population Health Strategies to Improve Health Outcomes and Reduce Medical Costs in the US Employer Group Sector
Population health is often associated with differentiations of age, chronic condition, or location. The purpose of this session is to look at a different population: the US workforce employed by large US employers. Premise Health operates pharmacies dedicated to treating employees and eligible dependents of contracted employer groups and aims to increase participant knowledge about this population and introduce creative strategies to effectively manage workforce population health, specifically using pharmacist-led interventions.

By the end of the session, participants should be able to understand the current health state and underlying causes of gaps in health outcomes for the workforce population. Participants will also learn about financial and care models currently utilized at Premise Health that allow pharmacists to provide customized, value-based care in a community/ambulatory hybrid setting. Applications of these models will be demonstrated through patient testimonials and pharmacy site case studies. Real-world results will be shown through clinical outcomes, cost-savings, and both patient and employer satisfaction data.

Learning Objectives
1. Define population health and detail forecasts, trends, and pharmacy-specific strategies of population health management.
2. Describe the role of health and well-being in large employers' workforce strategy as well as barriers to executing that strategy.
3. List pharmacist-led, value-based care initiatives and interventions that led to positive clinical outcomes aligned with large employers' health and well-being workforce strategy.


Kaitlyn Galan, Director of Clinical Pharmacy, Premise Health
Philecia C. Avery, Associate Vice President of Pharmacy, Premise Health

Advancing the Quality of Oral Anticancer Medication Use
PQA is working to advance medication use quality in the oncology space, and staff will provide an overview of quality issues related to oral anticancer medication use and strategies to address these issues.

Learning Objectives
1. Identify quality issues related to oral anticancer medication use.
2. Discuss the challenges related to measuring the quality of oral anticancer medication use.
3. Describe efforts to address quality of oral anticancer medication use.

Melissa Castora-Binkley, Senior Director, Research, Pharmacy Quality Alliance
Loren Kirk, Senior Director, Strategic Partnerships, Pharmacy Quality Alliance
Ben Shirley, Senior Director, Performance Measurement, Pharmacy Quality Alliance

Continuing Education Information