Clinical quality measures are a top priority in healthcare today. With reimbursements now directly tied to quality measures, payers are increasingly incentivized to maximize their plan’s performance and ultimately improve their Centers for Medicare and Medicaid Services (CMS) Star Ratings, Healthcare Effectiveness Data and Information Set (HEDIS) scores, and standardized core quality measures (CQMs).
With that said, effectively and efficiently improving performance is easier said than done—at least without the right strategic approach and technology to support the effort. Let’s talk clinical quality measures—specifically those related to medication adherence—and look at a few steps health plans can take to elevate their performance:
1. Determine the Reasons for Non-Adherence
One of the first steps you can take to improve health plan performance across clinical quality measures is to understand what’s going wrong. What are the primary reasons medication non-adherence occurs among various patient populations? Are those barriers to adherence intentional or accidental?
Identifying the root causes for medication non-adherence and understanding the psychology behind them can help health plans optimize their patient support programs to more effectively initiate behavioral changes. From there, you can develop a tailored strategy to address these barriers to adherence and improve your organization’s clinical quality performance.
2. Prioritize Your Quality Improvement Efforts
Once you have a solid understanding of the reasons behind non-adherence, you can utilize data to focus on improving the right measures. Look at which clinical measures are the most heavily weighted, such as triple-weighted adherence measures, and determine whether it makes sense to focus on increasing those scores.
You can also identify quality measures that impact each other. For instance, certain Medicare Advantage Part D measures, such as Statin Use for Persons with Diabetes (SUPD), directly impact Part C measures like Diabetes Care (Blood Sugar Controlled). Knowing which clinical quality measures have a downstream effect on each other is essential when developing your overall quality improvement strategy.
3. Personalize Interventions for Each Individual
With a clear idea of which clinical quality measures you’d like to focus on improving, you can develop an omnichannel patient engagement strategy to guide your interventions. Start by targeting high-risk patients who are most likely to benefit from a personalized medication adherence intervention.
No two patients have the same challenges or needs, so personalization is ultimately key when it comes to influencing meaningful and lasting behavioral change. Make it a point to personalize patient interventions for each individual by channel, content, timing, and frequency for the greatest impact. This way, you can ensure the right patients receive the right message, via the right channel, at the right cadence, and at the right time.
Improve Clinical Quality Measures with Smart Data
Artificial intelligence (AI) and machine learning (ML) separate regular data from smart data, which is being used more and more to deploy personalized interventions to improve adherence, close gaps in care, and boost quality performance.
AllazoHealth’s AI engine uses smart data pulled from a number of large, varied datasets to inform clinical decision-making and deploy more effective patient interventions. Data-driven patient support programs save payers time, money, and valuable resources, all while helping to improve quality performance and achieve desired outcomes.
If you’re curious about using smart data to enhance your patient support programs, AllazoHealth’s AI engine may be the perfect solution to drive quality improvements. Schedule a demo and see what smart data can do for your organization.