When considering the value of medication adherence, we have typically spoken of improving this aspect of healthcare quality through measures of PDC rates for the triple-weighted CMS Stars adherence measures; however, beyond the health benefits and quality score improvements, research has illustrated savings in total cost of care through improved medication adherence. So how can health plans quantify these savings from improved adherence?

RxAnte’s clinical programs are powered by our Value of Future Adherence™ (VFA) software, which helps plans enhance their observations around members’ medication use throughout the calendar year. This is achieved through customized outreach programs that are best suited to positively impact their members’ medical spend.

What is VFA?

Value of Future Adherence is another method for health plans to look at their members’ medication use–specifically in terms of a VFA score, or potential cost savings by improving a member’s adherence across a subset of therapies. In leveraging VFA to construct adherence programs, health plans are able to focus on a variety of medications that have a considerable impact on their populations’ medical costs. Unlike Stars-driven intervention outreach focused on triple-weighted adherence measures, VFA delivers consistent recommendations for member outreach over the course of the year and over a broader member population due to the more diverse medication therapies that are eligible for targeting within the program.

Informed by the needs of a health plan’s unique member population and that plan’s cost saving goals, VFA identifies a subset of therapy areas from a dozen available that are optimal to include within a given adherence outreach program. RxAnte and health plan clients combine the selected therapy areas with a variety of intervention types, ranging from lower-effort interactive voice response for lower risk members to more intensive pharmacist calls for high-priority counseling, creating an optimized adherence intervention program for that specific member population.

Creating a VFA-powered Adherence Outreach Program

For one long-time RxAnte client, Value of Future Adherence provided much-needed assistance in improving adherence to a subset of five drug therapy areas beyond the health plan’s existing work with RxAnte on Stars adherence measures. With VFA, RxAnte helped this plan to consistently engage a broader subset of their high-priority members during a pilot project. What started as a Stars adherence program was expanded to include more therapies, more members, and allowed for more consistent outreach recommendations while furthering the cost-saving opportunities of the program.

The key to directing the right intervention type across the health plan’s target population is RxAnte’s risk stratification, which assigns a priority ranking for each member based on their VFA score and the corresponding cost-savings that are anticipated with that member’s medication regimen y. For example, comprehensive medication reviews were deemed the most effective for the health plan’s highest-priority COPD and CHF patients to optimize their regimens and ensure adherence. Other tactics made available for outreach included non-clinical adherence calls and interactive voice response (IVR) calls. This outreach program ultimately achieved the health plan’s benchmark goal that was set for medical cost reduction across all therapies.

With VFA, RxAnte is able to broaden the focus of improved medication use from standard Stars adherence measures to other important chronic condition maintenance medications. Within our own client plans, this approach has proven helpful in avoiding costly hospital readmissions and other health issues attributable to non-adherence

Interested in learning more about how we can improve adherence across your high-risk populations? Contact us today.