New and existing EQUIPP users may have questions as they navigate the platform as to what’s important in 2024. We hope we can answer some common questions and help you on your journey to quality measure improvement and improving medication adherence at your pharmacy. Let’s get started below.

Are EQUIPP and quality measure performance still important in 2024?

Yes! Even though the way accountability to quality measures are structured has changed, EQUIPP remains vital to financial success. It helps pharmacies understand quality-based programs and achieve performance goals for financial gain.

How are quality measures calculated?

• Adherence is based on patients having an 80% medication refill rate and is calculated using adjudicated claims data.
• There are exclusion criteria which are applied to populations to ensure accurate measurement (e.g., medications for off-label use, hospice, etc.).
• Measurement periods displayed and calculated are rolling six-month and year-to-date.

What are the differences between measurement periods?

• Rolling Six Month: This considers patients who filled prescriptions during the past six months (e.g., August to January).
  • In this time frame, they would have already had two fills qualifying them for the measure.
• Year-to-Date: This is the default EQUIPP view and covers all claims data from the beginning of the year.
• Read about an example patient scenario for each period.

Most health plan goals and earning opportunities are evaluated on the year-to-date measurement period. Pharmacies should focus on this timeframe to understand patient attribution and improve performance to meet health plan and revenue expectations.

Where can I find health plan program specific goals in EQUIPP?

• Look at the “Measure Performance” screen and QIP (Quality Improvement Performance) Table to see goals for each measure and health plan.
• On the top of the Measure Performance Screen, a character indicator and his distance to the green flag will show performance status for that measure or how far you are from hitting the measure performance goal.
• Benchmark data allows you to compare how your pharmacy is performing against other pharmacies and help you set a goal for yourself.
• The run chart provides a visual performance of how your pharmacy is trending over time.
• The QIP table is another space for you to refine your pharmacy performance goals. This table lists individual health plans and their attributed patients which you are filling for in your pharmacy by each measure, and unique program goal. This QIP table allows you to review your performance score and understand how far you are from achieving the program goal for that individual health plan. Achieving the program goals typically correlates with unlocking additional reimbursement for your pharmacy.
  • The Gap column will link to outliers that will require outreach to that patient to make sure they come back to the pharmacy to get their fill on time.

What can be done about patients with extenuating circumstances?

• Patients who passed away, patients no longer taking medications, or those who have switched pharmacies may still show up in EQUIPP, but adjustments are made later. It will take time as additional claims data is used for calculations.
• Stay focused on helping patients who can benefit from interventions.

What is the purpose of documentation in EQUIPP?

• Standard outlier documentation is for internal communication only.
• Documentation in “Enhanced Services” for programs like Controlling Blood Pressure and A1c is required to receive payment for interventions.

How can Pharmacies Earn Additional Revenue?

• My Programs offers bonus opportunities based on performance percentiles (data available in May 2024).
• Enhanced Services offers incentives for completing interventions like adherence monitoring, A1c testing, and blood pressure control.
• Know your contracts in Medicare Part D which are providing performance-based bonus dollars. Most still are, so be sure to work with your contracting folks to best understand the network programs you are participating in for 2024.

For answers to other questions you may have about EQUIPP, please visit our Knowledge Base. Tickets can also be submitted using [email protected], should you require further assistance. Make this your year to improve patient medication adherence.