Services to Improve Therapeutic Outcomes Improve Star Ratings

The Centers for Medicare & Medicaid Services (CMS) reated the Part C & D Star Ratings to provide performance and quality information to Medicare beneficiaries and help them select health and drug services during the annual fall open enrollment period.^1,2

Plans are rated on a 1-to-5 scale, with 1 star indicating poor performance and 5 stars representing excellent performance.¹

Approximately 68% of Medicare Advantage plans with prescription drug coverage typically had an overall rating of at least 4 stars in 2022, up from 49% in 2021.¹ Pharmacists can play an important role in improving Star Ratings through medication therapy management (MTM) services.

According to the CMS, Star Ratings apply to the following 5 categories²:

1. Access: measures that reflect issues that can create barriers to receiving necessary care

2. Intermediate outcomes: measures, such as blood glucose control for diabetes care, that can improve a patient’s health status

3. Outcomes: measures that demonstrate health improvement
4. Patient experience: measures that reflect patients’ perspectives of the care they received
5. Process: measures that capture services that can assist in maintaining, monitoring, or improving health status

Pharmacies can increase Part D health plan Star Ratings through chronic disease management, medication adherence, and medication management, (see Figure).^2-5

Medication adherence tracks the percentage of plan members taking prescribed antihypertensive, cholesterol, and diabetes medications as directed.^2,3 Medication adherence is critical and therefore considered
a triple-weighted Star Ratings measure.³ Medication management involves the percentage of MTM program enrollees who received a comprehensive medication review (CMR).^2,3 Chronic disease management is defined as the percentage of Medicare Part D beneficiaries, 40% to 75%, who were dispensed at least 2 diabetes medications and cholesterol-lowering statin.²

One study measured the impact of community pharmacist interventions at improving medication adherence at 25 independent pharmacies that implemented a program for patients 65 years and older who were Medicare Advantage Plan members.⁴

The study population included patients taking targeted medications, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, oral diabetic medications, and statins. There were 1263 interventions that met the eligibility criteria.⁴ Among patients who were nonadherent and became adherent, the average change in proportion of days covered (PDC) increased by 14% (P < 0.0001).⁴ Commonly reported barriers to patient adherence included forgetting to take medications (35.7%), regimen complexity (12.3%), denial (6.7%), and adverse effects (3.3%).⁴

The OutcomesMTM platform includes a Star Boost Adherence program for Medicare plans.⁵

Through a multichannel approach, pharmacies can choose the desired Star Rating for each adherence measure.

The target rate of members who reach at least 80% PDC can also be selected along with the goal of completed adherence interventions.⁵ Pharmacist interventions are driven by the Targeted Intervention Programs (TIPs) used in the Connect Platform to maintain medication adherence, and charts display the PDC rates 3 months pre- and post-MTM services.⁵ Through the OutcomesMTM program, services can also target members who are non-adherent or at risk of becoming nonadherent to drug regimens. These pharmacy services are available through the Star Boost Adherence program and include the following⁵:

• Adherence monitoring program: monitoring adherence, including checkpoints throughout the year to meet goals

• Medication synchronization: developing a common fill date for chronic medications

• Needs check-in: educating patients about the importance of adherence and how to overcome barriers

• Needs disease state education: educating patients about disease states, lifestyle modifications, and medication monitoring

• Needs 90-day fill: assisting patients with transitioning from a 30- to a 90-day supply to improve adherence

• Needs refill: ensuring patients have an adequate supply of medications on hand

• New therapy consultation: ensuring that patients follow up after initiating a new medication

Jennifer Gershman, PharmD, CPh, PACS, is a drug information pharmacist and Pharmacy Times® contributor who resides in South Florida.

References

1. CMS releases 2022 Medicare Advantage and Part D Star Ratings to help Medicare beneficiaries compare plans. Centers for Medicare & Medicaid Services. October 8, 2021. Accessed February 9, 2022. https://www.cms.gov/newsroom/ press-releases/cms-releases-2022-medicare- advantage-and-part-d-star-ratings-help-medicare-beneficiaries-compare

2. Medicare 2022 Part C & D Star Ratings technical notes. Centers for Medicare & Medicaid Services. Updated October 4, 2021. Accessed February 7, 2022. https://www.cms.gov/files/document/2022-star-ratings-technical-notes-oct-4-2022.pdf

3. What Star Ratings really mean to your pharmacy. AmerisourceBergen. January 6, 2020. Accessed February 9, 2022. https://www.amerisourcebergen.com/insights/pharmacies/what-star-ratings-really-mean-to-your-pharmacy

4. Daly CJ, Verrall K, Jacobs DM. Impact of community pharmacist interventions with managed care to improve medication adherence. J Pharm Pract. 2021;34(5):694-702. doi:10.1177/0897190019896505

5. Star boost adherence for Medicare plans. OutcomesMTM. Accessed February 9, 2022. https://outcomesmtm.com/health-plans/starboostadherence/