Achieving a Star Rating of 4.5 or more results in a 5% bonus for your health plan. Concentrating efforts on improving pharmacy measures for your population can significantly improve your odds of qualifying for these bonus dollars, which could equate to millions in revenue.
In a recent webinar, titled 3 Steps that Improve Star Ratings: A Focus on Medication Adherence, Health Dialog’s Pharmacy Director, Jenny Glennon, PharmD, MPH, discussed key strategies for optimizing the return on investment (ROI) of a Stars Rating improvement program. Specifically, Jenny emphasized the importance of engaging diabetes patients to improve their medication adherence.
Medication adherence is one of the most challenging, yet most impactful ways to improve Star Ratings. But why is medication adherence so challenging? Traditional programs typically focus on closing individual gaps in measure but scratch the surface when it comes to uncovering the root cause of non-adherence. The challenge also lies within the behavior of each patient. Behaviors, beliefs, and attitudes are extremely personal. To change these, you must move beyond treating patients as data points, instead focusing on holistic care that supports the needs of each individual.
Why Focus Medication Adherence Improvement Efforts on Patients with Diabetes?
Patients living with diabetes are a critical segment of your population; they are numerous and are working to manage a very complex condition. They often need or would benefit from extra support when it comes to their healthcare management routine. Extra assistance in creating a schedule for multiple medications, understanding their condition, and knowing what questions to ask their provider are just a few examples.
Patients with diabetes also have an intricate medication routine. Many of these individuals should be taking the “big 3” to manage their health: a diabetes medication, a statin, and a RASA. Adherence to these prescriptions can greatly improve a plan’s Star Rating since these specific measures are triple-weighted. When prescribed these medications, patients qualify for multiple Stars measures: 96% of people with diabetes fall into at least 2 of the 3 triple-weighted measures and 77% fall into all 3 measures. By specifically focusing on the “whole health” of diabetes patients versus focusing on individual measures and gaps in quality, you are targeting those that can greatly impact your Star Ratings and medication adherence performance. When you can get to the “root cause” of non-adherence with each patient, you may be able to improve all three measures for that patient at one time.
During the webinar, Jenny discussed 3 crucial steps to improving triple-weighted medications measures. Below is a brief recap.
Step 1: Address Gaps and Challenges of Your Current Medication Adherence Program
Prior to making any changes to your medication adherence program, it is important to reflect on your current program to see where any critical gaps may lie. Common gaps seen in today’s programs are:
- Patients are typically identified when they are already non-adherent, which may be too late to change behaviors
- The root cause of non-adherence isn’t addressed—even if you get the patient to be adherent today, he or she may not stay that way for long
- Not understanding what a vendor may be doing for outreach and whether they’re optimizing their efforts for future success
- Starting outreach efforts too late in the year but also not planning for future measurement years
Step 2: Build the Foundation for a Successful Medication Adherence Program
To improve the ROI of your medication adherence program, it is important to prioritize those patients who are likely to change their behavior. There is no point in using resources to contact someone who may never answer the phone or be receptive to the program being offered. Using unique data points and not solely relying on medical and pharmacy claims, can best illustrate who the ideal patient for outreach may be.
Predictive models and machine-learning AI also help to identify patients before it is too late. As discussed above, typical medication adherence programs find patients long after becoming non-adherent. Many are identified as non-adherent once a major health event occurs, like a heart attack or hospitalization. With analytic tools in place, patients can be found at earlier intervention points along their journeys—some even before they’ve become non-adherent.
Step 3: Uncover Patient Barriers to Medication Adherence
Improving program ROI also requires a focus on long-term results. By addressing the root cause of non-adherence versus simply focusing on closing individual gaps in quality, you can have significant impact on adherence results for years to come—not just in a single reporting year. According to Jenny, “Medication adherence barriers are not simply data points but pieces of information about complex individuals that must be uncovered and addressed appropriately.” Each patient must be carefully interviewed and coached on what affects and motivates them when it comes to finding their path to adherence.
By focusing on these three steps, health plans can build a solid foundation for a medication adherence program that will continue to scale as Star measure cut points continue to increase.
To read the full details associated with these 3 steps, download the webinar SlideShare presentation.