Quality Improvement and Measurement
UMass Medical School's Center for Health Policy and Research continually works to assess and improve the ever-changing MassHealth pharmacy program, which provides prescription drug benefits to Massachusetts Medicaid subscribers.
The quality assurance program includes constant analysis of the program to ensure it supports clinical, financial, and operational objectives and evolves in accordance with changes in federal and state legislation, regulation, or policy regarding pharmacy issues.
This encompasses a wide range of pharmacy program activities, including:
- Analysis of drug use patterns to indicate which drugs or therapeutic classes should come under review,
- Analysis of prescribing and fulfillment patterns to detect and prevent fraud, and
- Analysis of utilization management programs to ensure the right drugs are being prescribed for the right conditions by appropriate clinicians.
For example, the quality improvement and measurement program revealed a high prevalence of suboxone prescriptions, a drug used to treat opioid addiction. After reviewing the data, UMass Medical School's Center for Health Policy and Research found that more than 25 percent of the prescriptions were inappropriate. This led to changes in the benefit program and additional checks and balances in the pharmacy benefit processing system.