Qualidigm -Medicare Part D Prescription Drug Benefit Quality Improvement

Medicare Part D Prescription Drug Benefit Quality Improvement Initiative

Project Overview
What's New
Tools & Resources
FAQs
Our Partners
Project Team
Events

Project Overview

Imagine a health care system where every person receives the right care every time, and where staff and providers have the tools and resources to deliver that care. The Centers for Medicare & Medicaid Services (CMS) and Qualidigm are dedicated to realizing this vision.

Qualidigm, Connecticut's Quality Improvement Organization (QIO), is working to assist physician offices, pharmacists and Medicare Part D Prescription Drug Plans to improve the delivery of Medicare's Part D prescription drug benefits and to make certain patients receive the most appropriate medications to improve their health and quality of life. As your QIO, we are committed to helping clinicians deliver care that is consistently safe, effective, efficient, timely, person-centered and equitable.

Project Goals:

Qualidigm will partner with physicians, pharmacists and Medicare drug benefit plans to improve prescription medication delivery and safety by:

Identifying opportunities to improve prescribing patterns for Medicare managed care members with diabetes and to achieve cost efficiencies associated with care through the promotion of generic drug utilization for lipid control.

Statewide Goals:

Qualidigm will work with a targeted group of primary care physicians within a specific geographic location of the state based on volume of Medicare patients and generic lipid lowering drug utilization prescribing patterns.
Qualidigm will partner with the Connecticut State Medical Society IPA and Health Net to provide educational outreach in the form of academic detailing to physicians to improve their use of appropriate, cost-effective lipid lowering drugs to their Medicare patients with diabetes.

Qualidigm's Approach:

Our staff works with drug benefit plans and providers to improve quality of care by:

Partnership Building

Working with statewide organizations to create partnerships and share best practices to improve the quality of care delivered under the new Medicare Part D Prescription Drug Benefit.

Performance Feedback

Providing a detailed profile to physicians on their prescribing patterns for lipid lowering drugs for their patients who have diabetes.

Quality Improvement Training and Support

Delivering educational programs presented by a registered pharmacist on the topic of appropriate drug therapy based on utilization patterns for patients with diabetes.

Marketing and Communications

Recognizing outstanding quality improvement efforts through the Qualidigm Quality Awards program.

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What's New

Special Open Door Forum: Preparing Pharmacist for Part D 2007

The Centers for Medicare & Medicaid Services hosted a Special Pharmacy Open Door Forum on "Preparing Pharmacists for Part D in 2007" on December 4, 2006 at 2:00 PM EST. This Open Door Forum was used to discuss questions associated with people who have changed prescription drug plans, pharmacy coordination of benefits issues, Part D references and more. Slides are available at http://www.cms.hhs.gov/pharmacy.

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Tools & Resources

The Medicare prescription drug benefit became effective January 1, 2006. The names and locations of the prescription drug plans selected to administer the drug benefit in Connecticut can be found online.

Part D Prescription Drug Benefit Information

Information for plans and providers can be found on the CMS website.

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FAQs

Do Medicare drug plans need to have preferred drug lists?
All prescription drug plans, regardless of whether they are a Prescription Drug Plan (PDP) or a Medicare Advantage - Prescription Drug Plan (MA-PDP), are required to have a list of medically appropriate drugs (formulary) to treat most medical conditions. A formulary finder that provides an easy way to access each of the PDP's or MA-PDP's formularies is located on the Medicare website.