Each year, cut points are announced in the fall and Medicare Advantage Part D (MAPD) plans anxiously anticipate their impact on Star Ratings. This year in particular, we’ve seen some unexpectedly high rate changes as they relate to the triple-weighted medication adherence measures; most notably, cut points for the RASA adherence measure leapt up four percentage points. The instinctive reaction to this change can be discouragement. That’s normal, but we work closely with our clients to ensure they see the opportunities that remain. We want you to have that information too, so you can succeed in the fourth quarter of 2018 and prepare for 2019 in the process. To that end, we interviewed our vice president of client services, Kerri Petrin, to find out what tips, tricks, and advice she gives to health plans in times like these.
RxAnte: How can plans match and exceed cut points each year?
Kerri Petrin: Driving improvement is always the name of the game, and plans generally know this. I think what they sometimes aren’t able to do, and what holds them back the most, is reaching members who will actually improve. In other words, every non-adherent or poorly adherent member won’t respond well (or at all) to pharmacy or plan outreach. To meet and exceed cut points, plans need to drill down the data, or rely on partners who can drill down the data, to identify which members are actually going to respond to outreach and change fill and adherence behaviors. These are the members that are going to boost adherence and therefore boost improvement. This is simultaneously the easiest and most complex area for plans. It’s easy because you can pretty quickly figure out who is struggling with adherence, but then it’s complicated because you really have to analyze so many factors to figure out which ones are the right ones to target.
RxA: Each plan is so different, but are there high-level things all plans can focus on to improve?
KP: Different plans have different needs, it’s true, and most of those unique differences stem from geographies. So, for example, some plans will have local pharmacies where others have only big-chain retail pharmacies. Providers in the area may be easier or harder to engage. Most plans will have very distinct populations – like low-income or dual-eligibles, which can be harder to move. But there are things every plan can and should be working on anyway. In general, those things are related to intervention effectiveness, scale, timeliness, and targeting. The trick is to tailor those things around your geographical needs, adjusting your strategy to dial-in on those key opportunities. This is where plans often struggle because they don’t have the resources to get to the level of customization they need to really, truly use interventions the right way.
RxA: What are some ways plans can move the needle and what are some pitfalls they can avoid?
KP: Other than getting into the data like we talked about earlier, plans can move the needle by treating adherence as a year-round point of focus. Not like “keep it in mind” but more like “this is the center of what we do.” That kind of approach leads to success when it’s paired with other improvement tactics and strategies because it gives plans a greater pool of members to reach in the right ways and at the right times. We know this works because we look at data that shows which plans are succeeding and which ones aren’t, and we see that the primary differentiator is plans who start adherence strategies at the beginning of the year rather than right after cut points come out. This positions plans to get a sort of “surround sound” interaction with members that actually makes a difference and quite literally raises adherence and, ultimately, adds stars.
RxA: What is the one thing plans must do to prepare for inevitable cut point increases?
KP: Tiered strategies. Start the year’s strategy with the knowledge that cut points will rise, and anticipate a number of scenarios so you aren’t developing the strategy as you lose members and time. Plan for a number of scenarios, focus in on those, and stick with that strategy throughout the year rather than ramping up each fall. This is the only way to get ahead instead of scrambling to catch up.
I’d also be remiss if I didn’t encourage plans to reach out to us to help with this. We really do know how to get them ahead, and we have the systems and resources to get real ROI back in their pockets as they reach the bonuses they deserve from improved Star Ratings. We can help build these kinds of strategies into your organizational goals, and improvement will become a natural part of what you do. We help plans implement workflow solutions, like RxEffect, and sometimes make even small changes that boost ratings and adherence by big percentages. It’s pretty incredible to see and be part of that each year.