Efforts to improve clinical quality measures have become the norm for Medicare plans in the modern era of performance-based contracts. Payers are now incentivized to elevate their Centers for Medicare and Medicaid Services (CMS) Star Ratings in order to maximize quality performance and subsequent reimbursements—but to say the process can be daunting is an understatement.
Let’s talk about four ways you can improve your Medicare plan’s Star Ratings:
1. Eliminate Key Barriers to Treatment Adherence
Identifying and eliminating barriers to proper adherence is essential in influencing lasting behavioral change. Understanding the root causes of non-adherence and other medication-related gaps in care can help you determine the best long-term solutions to address them.
Try focusing on patient interventions that highlight the barriers to treatment adherence, such as high drug costs, adverse side effects, forgetfulness, mental health challenges, poor health literacy, or the social determinants of health (SDOH). More and more, payers are paying attention to the SDOH in order to better allocate resources to vulnerable, high-risk populations.
2. Identify Quality Measures That Impact Each Other
It goes without saying that payers should focus on improving scores in heavily weighted categories, such as those related to adherence. However, it’s also important to keep in mind that certain CMS quality measures have a downstream effect on each other, which can have an impact on overall Star performance. For example, Medicare Advantage Part D measures—such as Statin Use for Persons with Diabetes (SUPD)—can impact Part C medical care measures—such as Diabetes Care (Blood Sugar Controlled).
3. Use Smart Data to Guide Strategic Decisions
Your efforts to improve quality performance should be driven by smart data and technology. Artificial intelligence (AI) and machine learning (ML) empower healthcare organizations to predict non-adherence and medication-related gaps in care and make smarter, more strategic decisions regarding their patients.
Using AI and smart data, you can identify high-risk patients and prioritize patient outreach based on who is most likely to be influenced by an intervention. This also enables Medicare plans to better utilize resources and create more effective and affordable plans. Many plan decisions directly impact Star Ratings, and although some may increase cost, they can also improve adherence outcomes. It’s all about striking the right balance.
4. Deliver More Personalized Patient Interventions
Once you’ve identified which patient outreaches to target and which quality measures you’d like to improve, you can focus on delivering more personalized interventions. AI technology allows those responsible for increasing Medicare plan Star Ratings to pinpoint the best intervention channel, messaging, and timing for each individual patient.
In other words, delivering personalized interventions increases the likelihood of having a positive impact on the high-risk patients you’re targeting by ensuring the patients receive the right messaging, via the right channel, at the right time.
This is when AllazoHealth comes into play.
How AllazoHealth Can Improve Star Ratings
AllazoHealth’s AI engine helps payers and pharmacy benefit managers increase the effectiveness of patient engagement programs that focus on Star Ratings. Our AI technology not only improves individual gaps in care and medication adherence, but it also learns from each patient interaction, making improvements to optimize support programs over time.
Take Blue Cross Blue Shield of North Carolina (BCBS of NC) for example. BCBS of NC used the AllazoHealth AI engine to target Medicare Part D patients, achieving a 5.5 times uplift in medication adherence and a 23 percent reduction in intervention spend. Your Medicare plan could be next! Get in touch to discuss your quality performance goals and get a firsthand look at the AllazoHealth AI engine.
About the Author
William is passionate about helping people get the most from their medications. As CEO of AllazoHealth, he is driving the organization’s growth to improve adherence and patient support programs. William originally joined AllazoHealth as the Chief Operating Officer and as the organization expanded, moved into the CEO role. Prior to joining AllazoHealth, he served in a variety of leadership positions at CVS Health, including time as Vice President of Strategy and Vice President of Product Management. While at CVS Health, he delivered industry-leading clinical programs, including the award-winning Pharmacy Advisor program, which drove CVS Health clients’ Medicare Star ratings to their highest levels ever. Earlier, William served in the US Navy before getting an MBA from Northwestern University’s Kellogg Graduate School of Management; William also worked for Bain and Company and EMC before he moved to CVS Health.