According to 2021 CMS Stars data, the average medication adherence rate among all DSNP (dually eligible Medicare/Medicaid) contracts in the industry is 83 percent, compared to 85 percent among non-DSNP MAPD contracts. This illustrates the need to further improve health outcomes for this higher-risk population. The desire to provide care for these high-need Medicare beneficiaries means that plans who offer DSNP contracts need to look continuously for innovative ways to engage and reach these members to improve medication use.

One large, regional health plan historically has placed a significant emphasis on improving population health since launching their Medicare offerings. While the plan was experiencing stable growth in both Medicare contracts, they partnered with RxAnte in late 2017 because their adherence performance had become stagnant in the past year. Health plan leadership also wanted to drive greater population-level adherence results among more members within their lower-performing DSNP plan, which was 2.5 Stars for its Part D rating at the time.

After launching the adherence program in early 2018, RxAnte’s consultative recommendation was to separate interventions by contract so the Health Plan could optimize their DSNP program and increase their intervention capacity to target a greater percentage of their high-value membership. By allocating specific budget and intervention resources to their DSNP population ‘s unique member mix, they were able to implement the most effective intervention strategy. As a result of concentrating adherence efforts on their DSNP population and continuous program optimization, adherence measures within their DSNP contract have improved by up to six percent over the past three years.

Program Analysis: 

After partnering with RxAnte, an in-depth analysis of the Health Plan’s pharmacy and medical claims data was conducted to identify opportunities for adherence improvement. Previously, the Health Plan utilized the
same internal call team and capacity for their DSNP and non-DSNP contracts, despite vast differences between the two populations. Further analyses run by RxAnte depicted the estimated achievable population-level lift for each of the triple weighted adherence measures if they could reach a greater percentage of their overall population — particularly within their DSNP membership, which historically had not been the main focus. While the Health Plan was conducting extremely effective live calls internally, RxAnte’s simulated results illustrated the potential growth that could be achieved by increasing volume and diversifying outreach methods.

Goals and Optimization: 

After setting aggressive Star Rating goals for both contracts, RxAnte and the Health Plan determined that the best strategy was to split the intervention teams, allowing for dedicated internal resources to be allocated to each contract. This tactic was particularly important, as the DSNP contract contained ~90 percent of the Plan’s highest-priority LIS members, compared to only ~15 percent in their other plan managed by RxAnte.
By dividing resources between the two contracts, the Health Plan was able to customize the volume and type of interventions based on a holistic assessment of the non-adherence risk of each contract’s members.
Within these two programs, RxAnte strategically placed contract members into risk categories based upon on previous fill behavior and RxAnte’s Value of Future Adherence® Score (see RxAnte’s Member Risk Stratification below). Doing so would help to ensure that the right intervention could then be deployed to the DSNP contract members that would benefit the most from a particular form of outreach.

Implementing New Intervention Tactics: 

After learning where members in the DSNP plan fell across the risk stratification, RxAnte worked with the Health Plan to tailor an individualized portfolio of suggested interventions to maximize their budget and outreach effectiveness. To reach a greater percentage of their population, RxAnte recommended that the client consider adding an automated refill reminder call to influence more low or moderate-risk DSNP members in a cost-effective way. The addition of this intervention would allow the Health Plan to save their more time-intensive and expensive live calls for higher-risk members, identified by RxAnte’s prioritized weekly target lists. Beginning in August 2018, the Health Plan followed this recommendation and began deploying IVR (interactive voice response) calls managed by RxAnte, in addition to continuing the successful internal live call outreach to the higher priority membership.

Scaling Outreach:

Prior to RxAnte, despite how effective the Health Plan’s live calls were, they were not able to reach enough of their membership to continue experiencing meaningful population-level adherence lift; however, as a result of diversifying their interventions, the Health Plan’s dedicated DSNP outreach team was able to conduct a higher volume of live calls to reach those members who would benefit the most from outreach,
while further supplementing the program’s volume with IVR calls. After a full year of conducting both IVR and live calls, the Health Plan was able to reach 47 percent of their adherence population, versus only
13 percent the prior year. After three full years of consistent program optimization, the Health Plan and RxAnte have been able to find a successful, balanced approach for the Health Plan’s membership. At the end of 2020, the percent of total members recommended for the DNSP contract was 77 percent, compared to only 34 percent in 2017.

Looking Ahead:

Moving forward, the Health Plan is focusing on how to continue scaling their DSNP program in an efficient way. With RxAnte’s collaboration, the Health Plan will further consider innovative ways to target the right volume of people while avoiding member abrasion. This includes considering new intervention channels such as SMS texting and a high-value, comprehensive pharmacy program through RxAnte’s newest intervention, Mosaic Pharmacy Service. Aligned with RxAnte’s recommendations, the Health Plan continues to utilize optimal targeting to effectively engage with their DSNP population. While the Health Plan awaits final 2020 Star Rating results, RxAnte’s forecast predicts that the DSNP contract will improve another 2 percent in diabetes medication, 3 percent in RASA, and 4 percent in statins compared to their 2019 performance. Additionally, when the Health Plan first began working with RxAnte, they were only able to reach 33 percent of their DSNP population; however, at the end of 2020, 40 percent of the DSNP population had been reached by one of the interventions deployed on behalf of RxAnte’s target list, representing a 21 percent increase in reached members.

After working with RxAnte’s dedicated team, the Health Plan’s DSNP contract is estimated to improve 7% in diabetes medication, 7% in RASA, and 10% in statins.

Download Now