Year after year, CMS Five-Star Ratings are becoming harder to both achieve and maintain. Knowing what strategies to implement and prioritize in order to maximize the return on investment (ROI) associated with your patient outreach programs can be challenging. However, by focusing efforts on improving medication adherence and statin utilization across your diabetes population, you can maximize your success by targeting multiple Star Rating measures at once.
Pharmacy measures and medication adherence weigh heavily on your aggregate Star Rating. 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.
However, improving medication use can be difficult. Patients struggling with medication adherence often do so because medication-taking behavior is extremely personal and patients aren’t always conscious or aware of the risk of nonadherence. To change these behaviors, you need to focus on a patients’ beliefs, attitudes, knowledge gaps, and skillsets. Most importantly, you must stop treating patients as data points or “single measures” to improve and focus more on holistic care that addresses the needs of each individual.
Furthermore, patients with diabetes are working to manage a complex condition and will benefit from extra support. These patients are taking multiple medications to manage their condition like an oral diabetes medication, statin, and RASA, all of which fall into triple-weighted measures. By focusing on patients taking multiple-measure qualifying scripts, health plans can use limited resources more efficiently.
Recently, I hosted a webinar, titled 3 Steps that Improve Star Ratings: A Focus on Medication Adherence, where I specifically discussed steps and strategies for effectively targeting this critical population. After the presentation, I opened the floor to attendees with questions on the topic. Below is a list of some of the most pertinent questions I received during and after the live broadcast.
- What is considered “too late” for identifying a nonadherent patient?
First of all, it is really never too late but there certainly is an ideal time frame to help patients meet their medication adherence goals. Ideally, it is best to identify patients before they even become non-adherent by using predictive analytics. Being able to provide extra support to patients who likely need it is best done as early as possible. Changing behavior earlier to stay on the right track is easier than changing the behavior of someone who has been non-adherent for a long period of time.
To illustrate some of the key milestones in a patient’s journey toward non-adherence, we’ve put together a quick video that shows how patients can be “identified” earlier in this process. The video features a patient case study of a 67-year-old named Susan, along with her pattern of non-adherence over the course of several years. Click here to watch Susan’s medication adherence story.
- During the webinar, you mentioned the importance of having the “right staff” and right training for medication adherence coaching. Can you elaborate more on what that may be?
For my team, the right staff are those who are willing to learn and have great communication skills. It sounds corny but if I can hear someone smiling through the phone when speaking with them, that is a great start because we know we’ve made a connection with this person. The right training includes in-depth, advanced communication education and opportunities to observe and practice these skills while coaching patients on medication adherence.
- Your coaching concept of “Ready, Set, Go!” seems great but what is the difference between that and motivational interviewing or empathetic inquiry?
All three of these methods are patient-centered ways to communicate and assess needs and are designed to facilitate collaboration. However, motivational interviewing and empathetic inquiry are, in my opinion, communication techniques, whereas “Ready, Set, Go!” is more of a framework used to support behavior change that leverages advanced communication techniques. Empathetic inquiry is used most often for social needs screening, which is only one part of the “Ready, Set, Go!” process.
- What role do social determinants of health (SDOH) play in your coaching program?
SDOH play a large role in our coaching program, especially for medication adherence. Our goal is to identify and address the individual needs of each patient since these are unique to each person. Our approach works by helping patients recognize their own concerns, preferences, values, and the implications of each.
We also incorporate SDOH information in our medication adherence predictive models and patient stratification processes to conduct the most effective and efficient outreach possible.
- You talk about how machine-learning AI can help to identify patients that are likely to improve their medication adherence. Can you elaborate on some of the data elements, outside of medical and prescription data, that are used to predict this?
Claims data helps you find patients who are not adherent, but they don’t provide the full picture or help you to identify those who are likely to be adherent in the future. It is essential to incorporate other data points to build a complete patient profile, for example:
By building the most complete profile to target patients, it can ensure your medication adherence program is prioritizing the right patients for outreach. These predictions can help to identify patients who are likely to become non-adherent, likely to be receptive to health coaching, and likely to change their behavior, among others. We also know that certain characteristics like living alone, having multiple conditions, being younger in age, and not being enrolled in a prescription refill program make patients more likely to not be adherent to their medications.
- Do intervention levels vary by patient? When is a high-touch intervention necessary?
Yes, some patients need a higher-touch intervention to improve their medication adherence. Being able to interview patients to understand which patients need additional support is key. Evaluating and addressing barriers can provide insight as to which patients need more frequent coaching calls and support. For example, patients like Susan, whom I discussed during the webinar, need more support. She is facing complex conditions and several barriers, such as time management, limited knowledge about her condition and medication, and lack of motivation to stay on track. Although these barriers may impact each patient differently, we see them frequently across every population that we work with. You can read more about the top barriers we see in populations here.
There are many components that go into a successful medication adherence program. Building the right foundation, targeting patients who are likely to change, and supporting them in ways that build behavior change are all important to boosting medication adherence and, in turn, Star Ratings. The questions answered above only give a small glimpse into what is really needed to move the needle.
If you are interested in learning more about improving Star Ratings while focusing on pharmacy measures, download the full 30-minute webinar: 3 Steps that Improve Star Ratings: A Focus on Medication Adherence.