This year, sharp cut point increases have created a steeper quality measures scale than in years past. Those of us in the industry certainly expect cut points to rise, but not at this magnitude. It has tremendous implications for both mid-range and high-performing plans. Medicare Advantage Part D (MAPD) plans and health plans with prescription drug plan (PDP) coverage will have to pull out all the stops to operationalize and optimize their medication adherence strategies. If you’re feeling the sense of urgency to accomplish this – we understand. Our recommendation is to focus in on these triple-weighted quality measures to achieve higher Star Ratings (and the bonuses that come along with it). Here are some places to start:
(1) Plan ahead, but, if you can’t, react with intention.
Ideally, you don’t want to be developing your strategy while members are becoming non-adherent, but sometimes it’s hard to get ahead. If you find yourself caught by surprise, you can still take back control of your quality measures by rethinking your targeting. Ensure you’re deploying measures not just to those you’re able to reach, but to those who are able to become adherent.
4+ Stars Requires Solid Medication Adherence Strategies
We help clients with tough populations reach the right members at the right times and in the right ways. Quickly, efficiently, effectively. If you’re not happy with the Star Ratings you (or your competitors) achieved in 2017, let’s talk about turning 2018 (and beyond) around.
(2) Track and tune with the right numbers.
Because CMS produces cut points with a cluster methodology, plans can have a hard time tracking where they are throughout the year. It’s difficult for them to anticipate where they need to be and know where they’ll end up when the next cut points are announced. This is especially true if you’re only using lagging indicators (such as rolling 21-month proportion of days covered/PDC or late-to-fill data). This perspective also doesn’t let you see if your interventions are effective or you’re doing enough to drive population-level improvement. Use data to predict and forecast performance before patients fall off – because then it’s too late for them to change in time to impact your stars performance.
(3) It’s never too late to collaborate – internally and externally.
Stars, pharmacy, quality, data, and leadership teams sometimes work in parallel rather than in tandem. This creates inefficiencies and reduces your ability to scale adherence solutions. Take the time to be good partners with one another internally (and find some to partner with externally as well – which we know a little something about!). Everyone involved must work together to determine factors that may or may not contribute to success. The need to team-up and get executive buy-in on critical adherence improvements is as true for plans thinking of what to do “right now” as it is for those planning their strategy for 2019.
The Opportunity in Adversity
Although we’ve all been taken aback by cut point increases, we’re encouraged to see health plan leaders rolling up their sleeves anyway – digging in and updating systems, strategies, and operations to get ahead for 2019. It’s also not too late to improve in 2018. Take stock of where you are now, and use that to inform how you react, track, and collaborate to move the needle in a way that gets the most “bang for your buck” for the rest of the year.