This article is part of a series on how community pharmacies demonstrate outstanding performance under measures that CMS uses to calculate health plans’ Star Ratings. Although pharmacies are not assigned Star Ratings, a pharmacy’s actions can have a dramatic impact on health plans’ ratings. Those ratings affect plans’ reimbursement and enrollment period.
A study in 2012 in the Annals of Internal Medicine estimated that nonadherence costs the U.S. health care system more than $100 billion per year and possibly almost $300 billion annually. Improving adherence not only improves patient outcomes, it also saves the health care system money.
So, to improve the quality of care that is delivered and to try to better control costs, Star Ratings have been created to measure the performance of Medicare plans. These ratings include three measures of drug adherence — and those measures are given triple weight among all Star Ratings measures.
Adherence is measured by the proportion of days covered. This is calculated using prescription claims that show how frequently a prescription is filled. The measure calculates the percentage of health plan members who have their prescriptions filled often enough to be adherent at least 80% of the time. For example, if patients who should be taking medications daily filled their 30-day prescriptions 12 times during the course of a year, they are said to be 100% adherent during the year. If the same patients refill their 30-day prescriptions only six times, they are adherent during those months when the prescriptions were filled, or only 50% of the time.
To qualify for a five-star rating in 2014, health plans needed to have adherence levels of at least:
- 79% for RAS antagonists in the treatment of hypertension
- 75% for statins in the treatment of hyperlipidemia
- 77% for oral diabetic agents in the treatment of diabetes
Improving adherence not only saves the health care system money, it also increases revenues for the pharmacy that fills the prescriptions, because patients receive more refills. (See “Improve Your Refill Rates and Revenue with Medication Synchronization.”)
Central Drugs in Portland, Oregon, had achieved a medication adherence rate of more than 90% for the high-risk patients it serves, such as people living with HIV and hepatitis C. By extending the practices it has used for those populations to conditions measured by Star Ratings, Central Drugs was able to rank in the top 20% of all retail pharmacies on those measures.
Central Drugs’ rolling six-month measures from May 2014 on the EQuIPP™ dashboard showed adherence of:
- 100% for hypertension drugs
- 100% for diabetes medications
- 4% for cholesterol medications
The pharmacy uses three interventions to produce better adherence:
- Medication synchronization. One of the many reasons for nonadherence is that patients forget to refill a prescription on time. One study found that patients with chronic diseases who were enrolled in an appointment-based medication synchronization program were 3.4 to 6.1 times more likely to be adherent than patients who didn’t have synchronized medication refills. Central Drugs uses technology from Prescribe Wellness to keep customers on track, by arranging to refill all their prescriptions at one convenient time.
- Adherence packaging. Studies have shown that packaging medication by dose, such as using blister packs, can improve outcomes. Seeing whether a patient has taken a dose of medication is much easier with adherence packaging than when pills are loose in a bottle.
- Behavioral health coaching. Medication nonadherence can be a complex issue with pcauses. Telling a patient, “You need to take your medication” isn’t likely to change that person’s behavior. Instead, take time to develop a rapport with your customers, so they will feel comfortable talking with you about their medications.
Once you understand the potential causes of their nonadherence, you can provide new information, such as why patients might still feel fine if they don’t take the medication, but nonadherence could be dangerous. By positioning yourself as a partner or coach to the patient, you can help that person set goals and define action steps that will lead to better adherence over time.
Improve Your Pharmacy’s Performance on Key Adherence Measures
Ideas for improving performance include:
Understand Reasons for Nonadherence
Tailor Solutions to Specific Reasons for Nonadherence
Patients may be nonadherent because they…
A pharmacy may be able to solve that issue with…
Don’t know why they need to take the medication
Medication counseling using a motivational interviewing approach
Forget to order refills
Electronic refill reminders, including IVR, calls, text messages and email (available through programs such as Your Pharmacy Online?
Forget to take each dose
Dose reminders or compliance packaging
Find it inconvenient to make multiple trips to the pharmacy to pick up multiple medications
Suffer intolerable side effects
Therapeutic interchange/prescriber collaboration
Can’t pay the cost
Therapeutic interchange, formulary review or patient assistance programs