CMS’s release of the 2021 Star Ratings cut points earlier this month reveals that—once again—RxAnte clients show improvement in adherence measures despite persistently rising cut points. For 2020, 90 percent of RxAnte-managed contracts are on track to improve adherence. While we await the release of industry-level performance in October, we’ll review the 2021 cut point changes, particularly among the SUPD measure, and look at how RxAnte clients are achieving improvement despite the challenging environment that exists for health plans.

The Impact of Rising Cut Points

We’ve noted the following most significant adjustments regarding 2021 cut points:

  • There are notable year-over-year increases for Diabetes and Statins within MAPD plans
  • The majority of rates are fluctuating +/- 1 percent for RASA, Statins, Diabetes, SUPD, and SPC measures
  • 30 percent of the Star Rating thresholds are increasing 2 percent or more on these adherence measures
  • SUPD is being weighted 3x retroactively and the threshold to achieve a 5 Star Rating in 2021 has increased by 4 percent

Across the board with RxAnte clients, we are seeing fewer members who are new to therapy this year, and many members are still avoiding provider visits due to the current pandemic. As the thresholds for SUPD have drastically increased and quality managers brainstorm how to achieve results in this triple-weighted measure, RxAnte’s unique solutions and partnership continue to help our clients drive adherence and achieve quality measure goals.

How Plans Can Achieve Results

RxAnte’s patented analytics enables clients to leverage a dedicated prescriber file that allows plans to pinpoint exactly who to target and when for the SUPD measure. Rather than waiting until Q4 to begin SUPD outreach, our health plan clients are seeing success when they begin intervention earlier in the year to ensure qualified members are not aging out of the measure.

Additionally, RxAnte clients are experiencing success by utilizing the powerful capabilities within RxEffect, our adherence workflow solution platform. Within RxEffect, qualified members are marked as an active SUPD opportunity; this allows teams to efficiently leverage existing adherence live call outreach to explain the measure to members and help them obtain a prescription.

And lastly, our clients have seen great success when using RxAnte’s prescriber lists to contact prescribers directly and ensure eligible members have the necessary Statin prescription.

With the help of RxAnte’s analytic capabilities and strategic recommendations, we are seeing that plans can improve upon this measure in 2020 and beyond. Contact us today to see how we can help you achieve your own adherence program goals regardless of fluctuating cut points.