Medicare Advantage Part D (MAPD) health plans inevitably have problems with scale when it comes to quality measure programs and strategic initiatives. Resources may be spread thin and funding may be challenging to acquire. Even if approved to implement, plans may be wasting dollars on the wrong methods or members, driving ROI down month-after-month.
We’ve seen this happen time and again with both regional and national MAPD plans. Plans see seasonal cut point announcements and realize they’ve spent the Star Ratings year focused on the wrong things.
To these plans we say, “It’s not too late.”
You can – and should – learn the best ways to get ahead at Star Ratings in our Field Guide to Creating and Managing an Effective Part D Adherence Program. In the meantime, here are some places to start making your quality measure programs scalable:
- Use predictions, or “forecasting.” We know many of you are looking at the data from CMS and other sources that provide you what you need to look retrospectively at how your programs are performing. These data sets, which include things like lagging prescription drug events (PDEs), don’t cut it. They can only tell you where you’ve been, not where you’re going. Instead, use data and systems that give you insights into the trajectory of your numbers and members. This allows you to adapt your overall program to get back on track at an enterprise level. Read more about retrospective vs. predictive analytics.
- Engage your networks – top-to-bottom and bottom-to-top. Research shows us two things clearly: the barriers to patient fill-behaviors and the tactics that help overcome them. Patients become non-adherent due to cost, education, and forgetfulness, among other things. They also trust and seek information from their providers and pharmacists. Leveraging your own networks of stakeholders expands your reach. Read more about pharmacy and provider activation.
- Use improved software and systems. Again, we know many of you are out there working on older, outdated, and often clunky systems. Many of you are also using highly manual processes to create lists, target members, and perform outreach. Healthcare technology is often decades behind other industry tech, but you do have options in this case. Stop wasting overhead on clinical workflows and start honing process efficiencies by getting proper technological workflow and projection support. Read more about workflow and quality measure solutions platforms.
Whether the next Star Ratings year is just around the corner or already underway, it’s not too late to drive bigger, better programs that help you address triple-weighted adherence measures at scale. If you’re ready to get competitive and find out how to improve your ratings, get your copy of the field guide and let’s talk.