Managing Compliance, Performance, and Outcomes

Learning Objectives: After reading this chapter and working through the case, the reader will be able to:

1. Define the term compliance and explain why it is important to pharmacy 2. Compare and contrast the terms law and regulation 3. Compare and contrast the terms standard and guideline 4. Define the term star rating and explain why it is important to pharmacy 5. Develop performance criteria and a procedure for measuring performance

of an important pharmacy activity

Introduction ............................................................................................................ 312 Laws, Rules, and Regulations ................................................................................ 312 Federal Laws .......................................................................................................... 312 State Laws, Rules, and Regulations ....................................................................... 316 Employment Law ................................................................................................... 317 Standards and Guidelines ....................................................................................... 317 Performance ........................................................................................................... 317

Medicare Star Ratings ....................................................................................... 318 HEDIS Measures ............................................................................................... 319

Outcomes ............................................................................................................... 319 Clinical Outcomes ............................................................................................. 319 Utilization Outcomes ........................................................................................ 319 Economic Outcomes ......................................................................................... 319 Humanistic Outcomes ....................................................................................... 319

Medication Adherence ........................................................................................... 320 The Joint Commission ........................................................................................... 320 Tips for Managing Compliance ............................................................................. 320 Summary ................................................................................................................ 320 References .............................................................................................................. 321

6. Define the term HEDIS, and explain why it is important 7. Compare and contrast the terms process indicator and outcome 8. Name four types of healthcare outcomes 9. Define the terms metric, adherence, baseline, and process indicator 10. Explain why there should be someone responsible for compliance and med-

ication safety in every pharmacy

This chapter is about managing compliance, performance, and outcomes. Compliance is making sure that policies, procedures, and activities are consistent with laws, rules, regulations, standards, and guidelines. Performance is about how well a certain activity is accomplished, and outcomes are the result of performance.