In this three-part blog series, we give MAPD plans the information they need to improve 2020 Star Ratings and get ahead of 2021 cut points.
In our last blog post, we began to discuss how Medicare Advantage Part D (MAPD) plans, amid so much market uncertainty, have the potential to not just control but improve their Star Ratings. Specifically, using analytics on medication use measures (which impact almost 50% of total Star Ratings) in four strategic ways:
- Identify members in a more intentional way.
- Refine intervention methods to meet members’ individual needs.
- Enhance predictive value to inform tactical execution and strategic planning.
- Impact care delivery by gaining greater control over where and how it happens.
We’ll discuss the first and second roles here and cover the third and fourth roles in a future blog post.
ASK: Are these really the right members to target?
Research conclusively shows multifaceted factors contribute to improper medication use and poor adherence among the Medicare population. Primarily, these members struggle with low health-literacy, high medication costs, cognitive impairment, lack of care continuity, and complex comorbid conditions that lead to polypharmacy. As a result, knowing which members to apply intervention and outreach tactics to is far from simple.
The “Right Members” Aren’t Just “Non-Adherent Members”
Among this deeply complicated population is a subset of “non-adherent” members. However, targeting every member in that category will ultimately lead to wasted resources and likely not advance your Star Ratings. This is because identifying the right members – those who are non-adherent and will be impacted by interventions – is twofold:
- Determine who is eligible for an intervention.
- Determine who will benefit from an intervention.
These questions must be answered in tandem – otherwise plans risk wasting money and resources on interventions that are likely to fail.
For example, plans may wait until the fall of each year to ramp up efforts to address poor medication use in an attempt to maximize the number of adherent members before the year’s end. Programs like this often fall short: It’s too late in the year for these members to positively impact the population-level adherence calculation, and interventions don’t target the specific reasons that members struggle with medication use.
Instead, plans should use a systems approach, treating the challenge of medication use as a set of interconnected elements, not a series of isolated factors. Applying analytics to the data that’s available through these elements, MAPD plans can begin to answer the five key questions of a cohesive strategy for improving medication use:
- Who is the target?
- What impacts the target?
- Where is the greatest impact?
- When should you reach out?
- Why should you intervene?
As an added bonus, this approach provides benefits across the care continuum:
- Health plans can increase member motivation for improved medication use.
- Providers can enhance communication with and educate members.
- Pharmacies can provide an additional clinical voice to advise on medication use.
ASK: Have we paired each member with the intervention they need?
Because different Medicare population segments have different needs, there is no one-size-fits-all approach to medication management. Analytics can help MAPD plans effectively target the right members, but it’s also critical to ensuring plans identify and apply the right interventions to the right members in both the short- and long-terms.
Right Members, Right Now – Effective Adherence Tactics
First, plans must identify which types of interventions will work best for which members. Part of this can certainly be done with fill data, but this primarily needs to be a predictive – not retroactive – activity. Plans need to look at the current needs of the current member population, while taking into account their behaviors and social determinants of health. This gives the most realistic picture of which members actively need to be intervened upon.
Methodologies for Ongoing, Population-Level Change
Next, plans must cross-reference the previously identified population to determine which types of interventions are best for achieving sustained medication use throughout that population. This is why in the previous step it was so important to bring in data that paints a holistic picture of a member’s health. Understanding the reasons prescriptions aren’t being filled or medications aren’t being used appropriately is critical to selecting interventions that will actually improve medication use for those members. For example, research has shown that different types of interventions (including behavioral, educational, risk communication, and self-management) as well as different modalities (such as text messages, phone calls, and/or in-person interventions) are more or less successful depending on members’ needs.
ASK: What else do I need to know about my members?
The bottom line is this: for MAPD plans, a lack of understanding of the varied needs of plan members and the resulting inability to solve for members’ unique barriers to adherence hurts plan Star Ratings. Understanding the unique social and financial determinants that impact members’ medication use (and therefore quality measure strategies) is a critical step in health outcomes improvement and improved pharmacy quality. Equally important is being able to predict where you’re headed during the year and how you can engage your members to succeed. Keep an eye out for our post next week on enhancing predictive value and impacting care delivery.
In the meantime, check out these other resources on understanding your members:
- Seniors and Polypharmacy
- Low-Income Subsidy Members
- Understanding Member Behaviors
- Projected Medicare Population-Level Developments