Health Plans & PBMs
Challenge: Improving adherence efficiently across large patient populations to improve outcomes and financial performance
Medicare Advantage Plans are now accountable for improving medication adherence as part of the CMS Star Ratings.
Because they are considered intermediate outcomes, CMS “triple weighted” three medication adherence measures for patients prescribed oral diabetes, cholesterol, and blood pressure medications. Measures of adherence to these medications together account for 28% of the Part D component of the Star Ratings, and 11% of the overall Star Rating.
Large bonus opportunities have created a new urgency to increase Star Ratings. The difference in bonus opportunities available to a “3-Star” plan with 500,000 members and otherwise similar plans that earned “5 Stars” is approximately $90-100 million in one year.
RxAnte can help health plans determine the best management strategy for improving adherence scores and driving Star Ratings. Better Star Ratings can increase operating margins and attract new enrollment.