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Medication Management for D-SNP Plans

From 2006 to 2017, while the number of Dual Special Needs Plans (DSNPs) has hovered in the 350 range, while the number of DSNP enrollees has increased from under 500,000 to over 2,000,000 members.  As DSNP plans provide both Medicare and Medicaid coverage for members, CMS is continuously monitoring DSNP plans in an effort to help States determine which plans are providing quality health care coverage and care coordination . CMS regularly reports data collected from health plans. The data include health plan enrollment, quality measures, compliance information, payment information and other useful information that States can use as to monitor performance of the DSNPs with which they contract. States can readily find out important information about DSNPs in their state, such as:

  • Which DSNPs are growing their enrollment the most each year, and in what counties?
  • How do the D-SNPs in a state compare with regard to various quality measures, such as “Care for Older Adults?”
  • What percentage of D-SNP enrollees in the state are assessed for functional status?
  • Which D-SNPs in the state have the highest percentage of enrollees who are voluntarily choosing to leave their plans?
  • Which D-SNPs in a state submitted Corrective Action Reports?
  • How much are the D-SNPs in a state receiving in Medicare rebates that can be used to provide benefit enhancements such as vision and dental benefits?

DSNPs and Quality

While States can use the Medicare Advantage (MA) STAR ratings to assess the quality and performance of MA plans operating in their state, STAR ratings are calculated at the contract level.  A single MA contract may include more than one type of SNP, as well as non-SNP plans and plans whose membership spans multiple states.  Consequently, the STAR rating assigned to a contract applies to all plans under the contract making it difficult for a State to compare DSNP plans in an “apples to apples” fashion. To allow for more comparable quality results CMS contracted with NCQA to develop a strategy to evaluate the quality of care provided by SNPs.  NCQA established Healthcare Effectiveness Data and Information Set (HEDIS) measures specifically for SNPs.  SNP HEDIS measures are tracked at the plan (vs. contract) level allowing States (and the SNPs) to use HEDIS performance data to identify opportunities for improvement, monitor the success of quality improvement initiatives, track improvement, and provide a set of measurement standards that allow comparison with other plans.  SNPs report on the following HEDIS measures:

  • Colorectal Cancer Screening
  • Care for Older Adults
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  • Pharmacotherapy Management of COPD Exacerbation
  • Controlling High Blood Pressure
  • Persistence of Beta-Blocker Treatment After a Heart Attack
  • Annual Monitoring for Patients on Persistent Medications
  • Medication Reconciliation Post-Discharge
  • Potentially Harmful Drug-Disease Interactions in the Elderly
  • Use of High-Risk Medications in the Elderly
  • Osteoporosis Management in Women Who Had a Fracture
  • Antidepressant Medication Management
  • Follow-Up After Hospitalization for Mental Illness
  • Board Certification
  • Plan All-Cause Readmissions

It is interesting to note that he majority of these HEDIS measures are drug related measures and can be managed and improved using a medication management approach.

DNPS and Care For Older Adults

The Care For Older Adults (COA) HEDIS measure is specifically interesting from an MTM perspective.  COA evaluates the percentage of adults 66 years and older who had each of the following during the measurement year:

  • Advance care planning
  • Medication review
  • Functional status assessment
  • Pain assessment

Two of these – Medication Review and Pain Assessment – can be completed by a clinical pharmacist.

Care For Older Adults and MTM

If a plan has designed their Part D MTM program correctly, then each CMR should not only add to your CMR rate, but should also add to the Medication Review and Pain Assessment components of your COA measure.  The standard CSS Part D MTM program includes both Medication Review and Pain Assessment that is provided via a provider consult not to the member. To address, COA in non-MTM eligible members CSS has rolled out a DSNP HEDIS Companion program which can be operated in conjunction with the core Part D MTM program.  The DSNP HEDIS Companion program uses a medication management approach to assure that plans are maximizing their COA – Medication Review and Pain Assessment quality metrics.  The DSNP HEDIS Companion program can also be expanded to include any or all of the following drug-related HEDIS measures:

  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  • Pharmacotherapy Management of COPD Exacerbation
  • Controlling High Blood Pressure
  • Persistence of Beta-Blocker Treatment After a Heart Attack
  • Annual Monitoring for Patients on Persistent Medications
  • Medication Reconciliation Post-Discharge
  • Potentially Harmful Drug-Disease Interactions in the Elderly
  • Use of High-Risk Medications in the Elderly
  • Osteoporosis Management in Women Who Had a Fracture
  • Antidepressant Medication Management

For a demo of the DSNP HEDIS Companion program contact us for a web demo. Best – Jim Jim Notaro, RPh, PhD Founder and Chief Clinical Officer

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