Help for a Struggling Adherence Star Rating

Improve Your Adherence STAR Rating

According to a recent report by the Centers for Medicare and Medicaid Services (CMS), over 30% of the nearly 500 Medicare Part D plans rated for the Part D medication adherence measures (Diabetes, Hypertension and/or Cholesterol) received an adherence STAR rating of three or less for 2016.

Plans falling within this 30% are faced with a challenge – and an opportunity – to improve the quality of care received by their members.

Non-adherence can be the result of a number of factors, many of which lay outside of a plan’s control, including transportation struggles, a member’s lack of social support or understanding of the medications prescribed, and forgetfulness or cognitive impairment. Regardless of the reason, non-adherence can result in increased costs due to hospitalizations and negatively affect your plan’s adherence STAR rating and your members’ health.

To assist plans reporting a low adherence STAR rating, CSS offers AdherencePath – a medication management service managed by CSS’ clinicians and MTM professionals to identify your non-adherent members and their barriers to adherence, and take appropriate, proactive measures to engage caregivers and prescribers in breaking down these barriers.

Adherence is a multifactorial problem – one solution does NOT fit all patients. Yet most adherence programs approach adherence as if it is uni-dimensional – applying only one strategy and hoping for significant results. CSS’s AdherencePath program focuses on understanding and remediating the etiology of sub-optimal medication adherence.

CSS’s proprietary software platform, MTMPath™, utilizes both medication possession ratio (MPR) and proportion of days covered (PDC) calculations. Based on plan goals (i.e. hypertension, dyslipidemia) these MPR calculations are applied to each chronic drug in a patient’s medication regimen to identify members who are struggling to maintain optimal medication compliance. This provides the medication management clinician with a specific therapy gap target to address in a patient intervention. PDC calculations are used primarily for reporting purposes to understand adherence at a population level. Neither is a complete metric and both must be used in a comprehensive adherence initiative.

CSS has reported improvement in the Part D Medication Adherence measures both as part of its Part D MTM program and stand-alone adherence improvement through the AdherencePath program. As a result, two-thirds of CSS clients have achieved a Five STAR rating for the Part D medication adherence measures.

In fact, one CSS client saw improvement from a Two to Five STAR rating in just one year in the medication adherence for hypertension measure.

To learn more about CSS’ AdherencePath program, contact us to set up a time to discuss your plan’s adherence goals for the coming year.