The revenue of Medicare Advantage plans is heavily dependent on their Star Ratings, and medication adherence is such an important quality goal that it is triple-weighted in the calculation of these ratings. CMS has taken notice. Thank you for playing a starring role! You may have some procedures or programs in place to simultaneously address adherence and CAHPS, but it’s often hard to manage both at scale without streamlined customer relationship management (CRM) system. Although di erent metrics under the Star Ratings program churn over time, the three medication HMO MA plans received an enrollment-weighted average Star rating of 4.07 this year, compared with 3.96 last year. The purpose of this study was to demonstrate if having a pharmacist-led MTM within a primary care clinic improve patient medication adherence outcomes/STAR Ratings. Medication adherence is critical to improving health outcomes and lowering total cost of care. RxAnte clients’ 4+ … A 4-Star rating system to grade health plans, where 1 Star is the lowest quality and 4 Stars represent the highest quality B. Over the past several years, the Five Star program has placed greater emphasis on medication adherence, continuously increasing cut points for RASA, statins, and diabetes medications. These measures are also triple weighted. Overall, we expect that the 0.1 lower average Star Ratings for 2021 will result in lower Medicare The pilot focused on diabetes, cholesterol and hypertension non-adherence, which are three-triple weighted measures accounting for up to 30% of Aledade’s Star rating. Although medication adherence measures are some of the heaviest-weighted in the Star Ratings calculations – in 2018 Medicare Advantage and Part D adherence measures were tripled rated – Johnson-Mills noted that most health plan efforts look at the unique needs of their patient populations. Many of the 46 Star measures saw increases, including the Medication Adherence and Statin Use in Persons with Diabetes (SUPD) measures, which now make up 15% of the overall Star Rating. STAR RATING Choose your desired Star Rating for each adherence measure. ... Tools are available to help you monitor your pharmacy performance, in relation to medication adherence and star ratings. Most engagement strategies that seek to improve Star Ratings tend to focus on outcome and process measures, where specific member actions are vital to success. The CMS rating system includes three triple-weighted, clinical pharmacy measures related to medication adherence for: Hypertension medication: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) Diabetes medication: oral (excludes insulin) Help boost Star Ratings while earning a reputation for excellence in caring for diabetes patients. Of 10 triple-weighted ratings, 8 are related directly and indirectly to medication therapy and thus have the potential to be improved by pharmacist intervention. This post will focus solely on the impact on Star ratings. and lower premiums for enrollees.8 Star ratings are critical for accountability as well as the enhancement of customer choice, and a plan’s overall score is impacted by 3 MAPD triple-weighted medication adherence metrics: adherence to hyper-tension, diabetes, and cholesterol medications. Improving program ROI also requires a focus on … • Identify reason for non-compliance and attempt to resolve . Thank you for playing a starring role! You can do even more to improve Star Ratings by encouraging patients to have preventive healthcare visits, screenings and tests, educating them about medication adherence and side effects, and reaching out to those who do not comply with their care plan. Star Ratings have been created to measure the performance of Medicare plans. These plans are judged based upon 17 different measures, with five specifically dealing with drug therapy. This last measure is weighted more heavily than the other two, as it can impact up to 50 percent of a Medicare plan’s Star Rating. The Star Ratings program is one measure of adherence, and the associated tracking tools bring this issue and the patient into focus on a number of levels. Medication adherence is absolutely critical to Star ratings. Drug Pricing and Patient Safety8 D14 – High Risk Medication D15 – Diabetes Treatment D16 – Part D Medication Adherence for Oral Diabetes Medications Whether a patient needs maintenance medications, complex Disclosures ... Safety (triple weighted) Two year lag time. NCQA Health Plan Ratings vs Medicare Part C and D Stars Methodology FAQs 3 NCQA 2019 • Subcategory scores are calculated differently. This year, the average medication-related MA-PD measure score dropped, while the Statin Use in Persons with Diabetes (SUPD) measure—triple weighted for the first time—dropped .4 stars on average. For this reason, health plans focus on strategies to improve adherence. The Medication Adherence measures were at the top of this list with their traditionally narrow cut points and triple weighting. So, to improve the quality of care that is delivered and to try to better control costs, Star Ratings have been created to measure the performance of Medicare plans. These ratings include three measures of drug adherence — and those measures are given triple weight among all Star Ratings measures. On first fill of a medication, counseling can help improve adherence and education, which can impact Star ratings on triple-weighted adherence measures. In 2012, a weighting system for star ratings was implemented. Thus, medication adherence has … Improving Medication Adherence and Beyond August 2017 ... proving or maintaining a Medicare Star rating. Background: Low medication adherence is associated with worse clinical and quality outcomes. PHARMACIST INTERVENTION DRIVES ADHERENCE IMPROVEMENT Personal Pharmacist™ Hai Wu Stop and Shop Pharmacy 020 to their anti-diabetic medication. Research is needed to evaluate effective means of collaboration between health plans and providers. Of 10 triple-weighted ratings, 8 are related directly and indirectly to medication therapy and thus have the potential to be improved by pharmacist intervention.8 Helping ensure compliance and supporting MA plans in improving their star ratings is not a stand-alone effort for pharmacies. Both had a weighting value of 1, but with the 2021 ratings that came out last fall, SUPD became one of four triple-weighted Part D measures, which include Medication Adherence for Cholesterol (Statins). By achieving the higher rating, these plans are also subject to a bonus payment of around 5%. Addressing medication adherence remains important With at least one-third of Americans not taking their medications as prescribed, medication adherence has continued to impact Star ratings. In 2012, CMS incorporated three new medication adherence measures into the Star System. For the 2021 Medicare Part D Star Ratings, the plan ratings will be comprised of 14 measures including the five PQA measures that are positioned within the domain of Drug Safety and Accuracy of Drug Pricing. MAIN OUTCOME MEASURES: Changes in DTPs per patient and changes in five Centers for Medicare & Medicaid Services triple-weighted Star Rating performance measures. The timing of the interventions must be considered. HEDIS Measures and Technical Resources. One-on-one pharmacist counseling is associated with a 3.86 percent improvement in optimally adherent members across all measurable conditions. HEDIS includes measures for physicians, PPOs and other organizations. Medication Adherence Measurements Getting needed medications and refill reminders will be key to helping Part D triple weighted measures. 2015 Current Star Measures High risk medication in the elderly Adherence Pick the measures you want to focus on: Adherence for Diabetes 191 million people are enrolled in plans that report HEDIS results. Domain 4. Patients who used online or mobile tools to manage and refill prescriptions had an average proportion of days covered (PDC) of 79.4%, compared to 77.5% for the control group, which was not digitally engaged 5; Our Pill Reminder tool on the Walgreens App reminds patients when it's time to take a medication. Average Star ratings vary by product type Among all MA plans, local PPO plans received the highest enrollment-weighted average Star rating (4.16) this year, a significant improvement from last year’s 3.87. Adherence is measured by the proportion of days covered. Medicare Advantage health plans’ triple-weighted medication adherence measures have averaged a one to three star increase within the first year of … Simply put, a lack of provider trust, limited communication with a provider, delivery … Changing behavior across a population can be challenging. These ratings include three measures of drug adherence targeting chronic disease: 1) Medication Adherence for Diabetes Medications, 2) Medication Adherence for Hypertension, 3) Medication Adherence for Cholesterol. Star rating, based on three triple-weighted measures for medication adherence. 45 unique measures in the Medicare Part C and D Star Ratings framework relate in some way to medications, and the three that relate directly to medication adherence in common chronic diseases are triple-weighted measures. Over the past several years, the Five Star program has placed greater emphasis on medication adherence, continuously increasing cut points for RASA, statins, and diabetes medications. A higher percentage is better Adherence measures are triple weighted and account for 30% of … Improved medication adherence; ... Medicaid and Dual-Eligible plans—improve outcomes that impact Star Ratings and HEDIS while achieving significant cost savings. Provider Issues. However, most Part D measures are still in effect, meaning that health plans must focus on these measures to move the needle on 2021 CMS Star Ratings. These measures are also triple weighted. Triple-weighted measures include medication adherence for diabetes, hypertension, cholesterol and statin use in persons with diabetes; The power of medication behaviors influencing how a health plan performs cannot be overstated. *Measurement year 2018 Adherence Solutions for Every Step of a Patient’s Journey Walgreens focuses special attention on patients most in need of help with medication adherence, including those with the triple-weighted Star Ratings disease states of diabetes, hypertension and hyperlipidemia. Our adherence solutions at work. Allowing AvMed to focus on patients most in need, RxAnte will provide both population level tracking and strategy reports as well as member-level prioritized target lists. In 2012, a weighting system for star ratings was implemented. Timing. For Medicare Advantage plans, drug adherence is a key factor in Star ratings. Medication Adherence: A Critical ... (CMS) continues to acknowledge the importance of adherence consultation with patients. Medication Adherence for Chronic Conditions: This should be a top priority. Plan ratings can have a substantial impact on beneficiary enrollment. Aledade chose Surescripts Medication … On the same day, CMS released the Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program and Programs of All-Inclusive Care for the Elderly (referred to as CY 2021 Proposed Rule, going forward in … To summarize, after the medication adherence measures have been added to the Star Rating system, the overall adherence has been increasing (from … EQuIPP measures pharmacies based on three different criteria: adherence, comprehensive medication review, and statin use in diabetes. For high value, triple-weighted Star measures, you need a great partner with all the right tools, such as a nationwide network of MTM providers, predictive analytics and 21 years of MTM expertise. Can Significantly Impact Star Ratings Impacts 54% of Part D score and 19% of overall Star Ratings (Parts C & D) Part D Measures Weight High Risk Medication (D14) 3 Diabetes Treatment (D15) 3 Medication Adherence: Oral Diabetes Medications (D16) … For example, cut-point changes increased the enrollment-weighted average rating per individual metric for appeals auto-forward (+1.19), medication adherence for hypertension (+0.94), and improving or maintaining mental health (+0.93 Medication-related behavior influences 37.5 out of 75 estimated points achievable in the Star Ratings—or 50% of a Medicare Advantage health plan’s performance. D13 –Medication Adherence for Cholesterol (Statins) % of plan members who fill their prescription for a cholesterol medication (statin) 80% or more of the time they are supposed to. And timely and accurate data enables providers to efficiently prioritize patient outreach and improve outcomes. CSS HEALTH IS AT AMCP NEXUS 2018. • Utilize medication adherence report to identify those trending poorly (percent) on compliance . are an important way we engage with patients to help them stay adherent and ensure they receive an excellent customer experience. These ratings include three measures of drug adherence — and those measures are given triple weight among all Star Ratings measures. Adherence is measured by the proportion of days covered. Higher star ratings retain members and attract new ones. These ratings include three measures of drug adherence targeting chronic disease: 1) Medication Adherence for Diabetes Medications, 2) Medication Adherence for Hypertension, 3) Medication Adherence for Cholesterol. Quality care is a team effort. Fewer Hospitalizations. 5-Star Contracts A total of 23 contracts are highlighted on the Medicare Plan Finder with a high performing indicator indicating they earned 5 stars; 20 are MA-PD contracts (Table 3), one is an MA-only contract (Table 4), and two are PDPs The SUPD measure saw the most dramatic increase in cut points. Medication Adherence for Cholesterol (Statins) PDE 136 Medication Adherence for Hypertension (RAS antagonists) PDE 75 Statin Use in Persons with Diabetes PDE 66 8 2021 CMS Star Ratings: An Analysis Large proportion of contracts missed the 4 Star threshold 5 for HEDIS, HOS, CAHPS and PDE measures by as low as 1-2% Medication adherence to ACE-inhibitors/ARBs, HMG-CoA reductase inhibitors (statins), and diabetic medications are triple weighted. You can do even more to improve Star Ratings by encouraging patients to have preventive healthcare visits, screenings and tests, educating them about medication adherence and side effects, and reaching out to those who do not comply with their care plan. This is calculated using prescription claims that show how frequently a prescription is filled. Medication-related measures account for 52% of the overall Star Rating, so it makes sense to make adherence and CAHPS a dual focus when engaging with consumers. Many of the 46 Star measures saw increases, including the Medication Adherence and Statin Use in Persons with Diabetes (SUPD) measures, which now make up 15% of the overall Star Rating. Unlike other quality measures, where … especially true for the medication adherence and SUPD measures. The only single weighted measure is the process measure of MTM Program Completion Rate for CMR. In fact, 8 of the 47 Star measures are directly related to medication adherence, 18 of the measures (or 40%) are related in some way to medication-taking behaviors, and—overall—50% of the weighting for the aggregate Star Rating is tied to proper medication utilization. These measures are all triple-weighted and have an outsized impact on the plan’s Overall Star Rating. Influencing heavily weighted criteria tied to Star ratings and HEDIS measures mRPM addresses numerous Star rating and HEDIS measures tracked by MA plans, as well as other health insurers. These 3 triple-weighted measures represent 11% of the Star Ratings portfolio. Demonstrated improvements for the three CMS triple weighted Star Ratings adherence measures. These Part D measures heavily emphasize medication adherence, and several of these measures are triple-weighted. Targeted MTM services are designed to help plan sponsors improve performance for key Star measures, including the triple-weighted adherence measures. The percentage of MA enrollees in plans with 4 or more stars also decreased from 79% last year to … ACHIEVING NEW HEIGHTS WITH CMR RATES. Adherence is not just filling prescriptions—it’s helping patients grasp what their medications do and why it’s important to take them in compliance with the prescribed regimen. improved medicine adherence and higher star ratings. of the bulleted items below are triple-weighted for pharmacists, meaning that they have a substantial impact on STAR ratings.) • Educate patients about their condition and explain why the medication is … According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than the specific treatment itself. The Centers for Medicare and Medicaid Services (CMS) recently released the latest cut points for 2021 Star Ratings for Medicare plans. When we dug deeper, we learned that a few of the changes in cut-points did influence the Star ratings for MA plans. Average Star Rating* 3.55 3.62 3.34 3.50 * The average Star Rating is weighted by enrollment. Adherence is crucial to maintaining health for patients with these conditions. Our highest performing clients outperformed their high-performing industry peers. For example, the heavily weighted medication-adherence measures for chronic conditions such as diabetes, hypertension and cholesterol could be boosted by one Star point or more through mRPM. The provided predictive analytics will focus specifically on triple-weighted Star Ratings medication adherence measures including: adherence to blood pressure, cholesterol and diabetes medication. In 2012, a weighting system for star ratings was implemented. For example, cut-point changes increased the enrollment-weighted average rating per individual metric for appeals auto-forward (+1.19), medication adherence for hypertension (+0.94), and improving or maintaining mental health (+0.93 Star Ratings measures span five broad categories, each weighted differently: Outcomes (5) Intermediate Outcomes (3) Patient Experience (1.5) Access (1.5) Process (1) 4 intermediate outcomes measures (triple weighted) Medication adherence for Diabetes Medication adherence for Hypertension (RAS antagonists) *Measurement year 2018 As CMS pushes Medicare Part D completion rates to new heights, our team at CSS Health is bringing innovations to meet... MEDICARE STAR UPDATE FOR PHARMACY. the 2015 star ratings, CMS’s triple-weighted measures included Part D medication adherence measures for diabetes medica-tions, renin-angiotensin system (RAS) antagonists, and statins Measure Label Measure Description Data Source Weighting Value Medication Adherence for Diabetes Medications Our predictive modeling projects member adherence with 90%+ ACCURACY. New Star Rating cutoffs for 2017 are out. Medicare Part D Star Ratings and Pharmacy Performance. For example, the C15-Diabetes Care—Blood Sugar Controlled measure is directly linked to and correlated with diabetic medication adherence because this measure cannot improve without the proper medication regimen. These measures are triple-weighted inside the Medicare Stars rating program, indicating CMS’ recognition of the importance of appropriate medication use. – Star Ratings calculate domain scores using the average Medicare Part C and D Star Rating. Typical program outcomes for clients include 1-2 Medicare Advantage Stars improvement per year for triple-weighted medication quality measures and a … Plan ratings can have a substantial impact on beneficiary enrollment. As part of the interviews, several POs identified using ... Cholesterol (statins).
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