For payers, improving clinical quality measures for Medicare plans has become a top priority to boost Centers for Medicare and Medicaid Services (CMS) Star Ratings and maximize quality performance. Understanding how different measures impact each other is essential to improve performance—especially because adherence measures are so heavily weighted.
Learn which quality measures impact each other and how artificial intelligence (AI) can maximize performance across interrelated metrics:
Which Clinical Quality Measures Impact Each Other?
Certain clinical quality measures for both Medicare Part C and Medicare Advantage Part D can overlap and have downstream effects on each other. This is particularly true for those related to medication adherence and statins—a group of drugs used to lower cholesterol and reduce the risk of heart disease or stroke.
Medication Adherence for Cholesterol (Statins) is a Part D adherence measure that looks at the percentage of members with at least two fills for a statin who were adherent for at least 80 percent of the treatment period. The Medication Adherence for Cholesterol (Statins) quality measure overlaps with another critical Part D measure, Statin Use in Patients with Diabetes (SUPD).
SUPD measures the percentage of the diabetic Part D members who filled a statin during the measurement year. Two fills of an antidiabetic medication are required to qualify the patient as diabetic. SUPD is designed to prevent diabetic patients from developing clinical atherosclerotic cardiovascular disease (ASCVD) and is based on guidelines from the American College of Cardiology, American Heart Association, and American Diabetes Association.
Medication Adherence for Cholesterol (Statins) also overlaps with a statin-related Part C measure, Statin Therapy for Patients with Cardiovascular Disease (SPC). SPC captures the percentage of Part C members diagnosed with ASCVD that qualify for the measure and were prescribed at least one high-intensity or moderate-intensity statin during the measurement year.
Patients must have two fills of a statin medication to qualify for the statin adherence measure and will need to be at least 80 percent adherent to achieve the metric.
SPC and SUPD interactions with the statin adherence measure are interesting because interventions designed to close SUPD and SPC gaps in care can cause patients to qualify for the measure. However, if these patients are not adherent, they will depress the score on the statin adherence measure.
In addition to interrelated statin quality measures, Diabetes Care (Blood Sugar Controlled) overlaps with Medication Adherence for Diabetes Medications.
Maximize Interrelated Clinical Quality Measures with AI
Artificial intelligence (AI) can have a positive impact on individual adherence, helping payers and pharmacy benefit managers (PBMs) increase the effectiveness of patient support programs that focus on quality ratings. For example, AllazoHealth’s AI engine can maximize interrelated SUPD (or SPC) and statin adherence measures by predicting:
- SUPD metric qualification: Will the member achieve two fills of antidiabetics?
- Minimum statin fill rates: Is the member likely to have at least one fill of statins without a SUPD intervention?
- Response to interventions: How will members and prescribers respond to the tailored interventions? Will the interventions result in achievement of the SUPD or SPC measures? How will the intervention impact the qualification and achievement of the statin adherence measure for that patient?
Ultimately, AI can personalize targeting by tailoring the time and messaging cadence to optimize outcomes for both metrics, improving SUPD and SPC while also improving the statin adherence measure. However, without personalized targeting, you run the risk of negatively impacting your statin adherence measure in your efforts to improve SUPD and SPC.
From there, the AI recommends the optimal intervention channel and messaging to engage each patient and prescriber. Selecting the right timing and combination of prescriber and patient-focused interventions for SUPD and SPC is essential to achieve the interventions and drive adherence across the population.
Partner with AllazoHealth to Elevate Quality Performance
Walgreens is just one example of a pharmacy that partnered with AllazoHealth to improve patient adherence. Using AllazoHealth’s AI engine, Walgreens boosted efficiency, increased cost savings, and delivered more effective, personalized interventions that had a greater impact on diabetes, hypertension, and statin patients.
Get in touch to learn how partnering with AllazoHealth can help your organization elevate Star Ratings and overall quality performance.
About the Author
Dr. Linda Schultz
Dr. Linda Schultz is a results-oriented Healthcare Pharmacy Executive who excels at leading transformational, top-notch, interdisciplinary healthcare teams to create and execute outcomes driven clinical operations and account management initiatives. Dynamic and knowledgeable in all healthcare business segments, most passionately within the complex Medicare, Duals and Medicaid markets, she is an accomplished, creative motivator and driver of innovative quality and cost of care pharmacy interventions. Dr. Schultz is currently VP, Customer Success at AllazoHealth, a cutting-edge, healthcare artificial intelligence company. Prior to her leadership role at Allazo, Linda founded and led RxHorizons, LLC., an international healthcare consulting group. Her expertise stems from over 25 years of experience within the Managed Care industry, with a focus on leading, strategizing, developing and implementing pharmacy benefit management activities within national PBMs and health plans.