One of the surprises in the release of plans’ Star Ratings results for the 2019 open enrollment season was that Star Ratings around Part D adherence scores, on average, slipped.[1]
The Centers for Medicare & Medicaid Services (CMS) includes three adherence measures in the Part D domains including:
- Medication Adherence for diabetes medications
- Medication Adherence for cholesterol
- Medication Adherence for Hypertension
Medication Adherence Case Study
Prior to the release of this latest Star data, BluePeak was assisting a Medicare Advantage Plan with prescription drug coverage (MA-PD) that was targeting improvement on the Part D adherence measures, which had declined in a prior measurement period. After doing a full STARS program assessment with BluePeak it was decided to target these measures as part of an overall strategy to improve their Star summary rating, recognizing that measures like these are weighted a 3, as an intermediate outcome measure. Lack of adherence or improper medication use relative to diabetes, hypertension or hypercholesterolemia can result in poor health outcomes as well as increased cost of healthcare, which is why they are targeted and measured by CMS.
BluePeak analyzed plan data and identified the members who should be taking these drugs based on prior use and/or diagnosis. While BluePeak acknowledges that holistic data collection is more challenging for Prescription Drug Plans (PDPs) than MA-PDs Prescription Drug Event (PDE) or pharmacy claims data can provide a good starting point to identify gaps in care for medication adherence.
Based on the findings in the data, BluePeak assisted the Plan in launching a member and prescriber outreach program targeting members that appeared nonadherent. Outreach was made to both members and prescribers explaining the importance of the medication regimen and suggesting a 90-day refill at mail or retail to promote long-term adherence. In addition to suggesting refills, the information offered members an opportunity to speak with a Plan Medication Therapy Management (MTM) pharmacist about their medication.
The Plan’s drug adherence data is now being monitored on an ongoing basis so that outreach can be made to members who are newly prescribed any of the targeted medications. Studies suggest that many patients abandon a drug regimen within the first month or two of starting a new drug therapy. This early outreach provides additional support to new medication users as they become accustomed to the schedule or any side effects.
BluePeak also recommended that the Plan also make changes to their upcoming formulary strategy. Targeted medications were placed in lower cost and $0 copay tiers. Products with single dose administration were also placed in lower copay tiers because adherence is proven to be higher with once a day versus multiple times a day regimen.
The Plan has already seen an upward trend in medication adherence based on the initial and ongoing outreach. Over time, the benefits may be exponential through increasing member satisfaction and reducing hospital admissions or readmissions through medication adherence.
Broader Implications
As plans continue their work on Star ratings, CMS is also continuing to push plans to increase Star ratings. Plans must be vigilant in monitoring their data and creative with member rewards and incentive programs to maintain or improve their Star ratings.
The 2019 Call Letter, which allows plans to include quality improvement and member intervention costs in their bid, signals CMS’ ongoing and growing commitment to quality improvement and long-term health initiatives.
Whether plans are seeking improvements in specific Part C or Part D measures, the medication adherence case study demonstrates that some universal strategies apply:
- Integrate data to identify gaps in care
- Use that data to conduct targeted member outreach
- Engage health care providers
- Be open to making changes in strategy that may take time to affect change
- Interventions should be ongoing, not episodic
Many plans struggle with integrating disparate data to reconcile gaps in care and drive quality improvements. Even when this data is integrated, the process to target and identify members and implement effective strategies for members to take action that will drive results exceed the bandwidth of many plans’ current staffing and technology resources.
The most successful Star rating strategies will automate data inputs from a variety of sources, review real-time and actionable data, and provide rewards and incentives as part of member engagement to promote changes in health behaviors.
BluePeak can help
BluePeak’s Star Rating Program includes a powerful, automated, real-time and customized identification and intervention process focused on HEDIS and other clinical medication adherence measures, which helps plans focus on vital measures to achieve better member outcomes, better quality scores and higher Star Ratings for Medicare Advantage Plan Sponsors. BluePeak also provides consulting services, based on operational experience and interpretation of existing and new Star Ratings to provide guidance on best practices to close identified gaps in care and its impacts, as well as ongoing assessments of a Plan’s overall quality Stars program and processes.
[1] Fact Sheet – CMS 2019 Part C and D Star Ratings -Based on the 2019 Star Ratings published on Medicare Plan Finder (MPF) on October 10, 2018. For details on the Medicare Advantage (MA) and Part D Star Ratings, please refer to the 2019 MA Part C & D Star Ratings Technical Notes available at http://go.cms.gov/partcanddstarratings.
