“As health plans strive to meet the need for quality care among the Medicare population or otherwise, they will also have to lower costs. They will need to make better use of technologies, employing data-powered systems that tackle the root problems members have. To start with, plans will need to examine ways to integrate treatments and medical management and to use clinician interventions to improve medication adherence.”

Trends in Medicare

 For those of us who have been in the healthcare industry for a decade or more, we’ve not only witnessed the shift from fee-for-service payment models to value-based care, we’ve lived it. For Medicare Advantage (MA) and Medicare Advantage Part D (MAPD) plan leaders, this is a double-edged sword. It can make it easier to grasp the deep importance of members’ needs, behaviors, and expectations, especially as applied to MA’s largest populations (seniors and dual-eligibles). Conversely, it can create heightened sensitivity to the pressures that come with meeting the ever-growing demands of quality-related ratings, measures, cut points, and more. We see this among our MAPD clients all year-round, and we find that it helps to take a step back when looking at costs and quality.

Cost and Quality from the Inside-Out

When it comes to costs, plans can easily get caught up in the minutiae. Instead of changing that mindset, we challenge plans to lean into it to understand where costs really fit into the big picture:

  • They add up. Unnecessary readmissions, avoidable utilizations, incorrectly targeted interventions, overprescribing – dollar signs are attached to every “little” thing.
  • Attach value to every “little” thing. Keeping members from unnecessary readmissions and avoidable utilizations is valuable. Targeting members who will actually benefit from interventions is valuable. Creating better prescription practices is valuable.
  • Adherence connects the dots. To gain value from (instead of lose money on) elements like these that impact cost, it seems almost too simple: improved adherence can increase value.

By incorporating a higher-level view to identify commonalities among things that are valuable, we have also identified commonalities among costs and quality.

Because tackling one-at-a-time improvements to each and every component that impacts costs and quality would be laborious at best, it’s significantly more manageable to take on one root of problem: medication non-adherence. Plans can do this with solutions that focus on targeting and timing, scaling them across members and plans to effectively change member behaviors.

There are plenty of options out there to help MAPD plans improve ratings, but we’ve discovered these six things are necessary for success.

The Meaning of Value

Although it’s useful to take the 30,000-foot view of costs and quality to understand how to address them in the most impactful way (together), we also have to acknowledge it simply isn’t that easy for MAPD plan leaders. They do have to think about every detail, consider every member, account for every dollar. This is why we reinforce value versus costs or quality. Value is a measure of every detail, member, and dollar. It is a measure of what plans do for their members to truly achieve quality care, and approaching adherence as a method of improving value is one of the best ways to make this happen.

Don’t draw on overstretched budgets and overtaxed resources to try to improve adherence ratings in the final quarter of 2018 – we can help.