How Increasing Medication Adherence Can Boost Your CMS Star Rating

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It’s well-known that medication adherence plays a role in determining a Medicare plan’s CMS Star Rating. However, the level of impact that adherence has on this rating isn’t as well-known – and is much greater than you might think.

In this blog, we recap what increasing your CMS Star Rating can do for your health plan, and we dive into just how much adherence comes into play.

What a higher CMS Star Rating can do for your health plan

A high CMS Star Rating is essential for your health plan to achieve a good reputation and boost revenue.

First of all, one in five patients actually uses CMS Star Ratings when making healthcare decisions [I]. This means that the higher your Star Rating, the more likely you are to secure enrollment. As a matter of fact, a one-star improvement increases the probability that members will enroll in your plan by 8%-12% [ii].

In addition, financial rebates and bonuses are awarded each year to highly rated plans, while low-rated plans are excluded from such benefits. 4- and 5-star Medicare Advantage plans specifically receive pay-for-performance bonuses that equate to about $500 per member per year [iii].

When you take both member enrollment and financial bonuses into account, a health plan that jumps from a 3- to a 4-star rating can increase its annual revenue by 13.4%-17.6% [ii].

How medication adherence influences your CMS Star Rating
Hand placing medications in a pill box organizer

Each year, health plans must determine which CMS star measures to prioritize in hopes of increasing their overall Star Rating. It’s nearly impossible to allocate the proper resources to all required measurement areas, so plans must focus the most attention on the measures that will provide the biggest ROI.

According to the American Journal of Managed Care (AJMC), medication adherence has more impact on a health plan’s performance than preventive screenings and member appeals [iv].

Why is this? Many would attribute this statistic to the fact that the three medication adherence star measures are triple-weighted. While this certainly sways a plan’s final number, adherence’s influence is much more far-reaching than just the 3-times rating.

There is an extremely high correlation between adherence ratings and other measurements. Medication adherence accounts for close to 40% of a plan’s Part D Star Rating, and also influences several Part C measures (i.e. increasing medication adherence in diabetes patients can help improve the blood sugar control measure).

An analysis by AJMC breaks this down for us [iv]:

  • Eight measures are overtly tied to medication adherence or review
  • Six measures address specific health impacts that are tied to proper medication use and fewer hospital readmissions
  • Two measures relate to patient experience, one being how easy it is for consumers to get their prescribed drugs

When a health plan increases medication adherence in its member population, it sets a strong foundation for a bump in its overall Star Rating. To see specific data surrounding adherence’s influence on MA-PD and PDP 2021 Star Ratings, click here.

How to increase medication adherence in your member population

If we’ve convinced you that increasing medication adherence is where you should be focusing your efforts, it’s time we discuss the best ways to do so.

Some of the top reasons for medication non-adherence include:

  • Forgetfulness
  • Side effects
  • Cost concerns
  • Drug being seen as unnecessary
  • Trouble getting to the pharmacy

Digital interventions address all five of these reasons. For example, medication reminder apps combat forgetfulness by sending personalized reminder notifications to patients when it’s time to take their medications, and 2-way messaging systems for side effect questions increase adherence by more than 20% [v].

Apps like GoodRx save patients an average of 79% on their prescriptions [vi], and education interventions, such as digital medication leaflets, boost adherence by helping patients understand more about their prescribed drug and why they need to take it.

Finally, digital refill reminders ensure patients always have enough medication, and online pharmacies can help eliminate the need to physically pick up prescriptions.

Ultimately, what this all boils down to is that digital interventions help increase medication adherence by bridging the gaps between a health plan and its members. That’s why our team at Groove Health created an end-to-end medication adherence platform that keeps all stakeholders on the same page.

Clinical dashboard illustration with lines extending out, pointing to smaller icons

Our PredictiveRx Engine sifts through your claims data to identify members who are either non-adherent or at risk of becoming non-adherent. The platform then intelligently prioritizes your population to ensure that interventions go to the right member at the right time. These personalized interventions come in the form of our medication management mobile app and conversational AI chatbot, which you can read more about here. The app syncs to your clinical dashboard so you are consistently armed with live insights that can drive lower costs, better outcomes, and higher CMS Star Ratings for your health plan.

In a world driven by technology, healthcare is falling behind. Don’t let this hold your health plan back from achieving a good reputation and higher revenue. Start focusing your efforts on increasing medication adherence, and don’t be afraid of implementing digital solutions to assist.

To learn more about Groove Health’s best-in-class medication adherence technology, schedule a demo today.

Cover photo by Pixabay

In-line photo by Unsplash

[i] Heath, Sara. “One in Five Patients Use CMS Star Ratings for Healthcare Decisions.” PatientEngagementHIT, Xtelligent Healthcare Media, 19 June 2019, https://patientengagementhit.com/news/one-in-five-patients-use-cms-star-ratings-for-healthcare-decisions.

[ii] Bajner, Richard, et al. “The Impact of Star Ratings on Rapidly Growing Medicare Advantage Market.” Navigant, Feb. 2018, https://guidehouse.com/-/media/www/site/insights/healthcare/2018/medicare-advantage-analysis.pdf.

[iii] “Medicare Plans Score Higher Ratings and Millions in Bonuses.” Healthcare Finance, Kaiser Health News, 8 Mar. 2016, https://www.healthcarefinancenews.com/news/medicare-plans-score-higher-ratings-and-millions-bonuses.

[iv] Rose, Jason Z. “Medication Adherence: The Lever to Improve Medicare Advantage Star Ratings.” AJMC, AJMC, 26 Jan. 2021, https://www.ajmc.com/view/medication-adherence-the-lever-to-improve-medicare-advantage-star-ratings.

[v] Wald, David S., et al. “One-Way Versus Two-Way Text Messaging on Improving Medication Adherence: Meta-Analysis of Randomized Trials.” The American Journal of Medicine, The American Journal of Medicine, 15 June 2015, https://www.amjmed.com/article/S0002-9343(15)00519-7/fulltext.

[vi] Nguyen, Amanda. “The GoodRx Effect: How GoodRx Is Changing the Economics of Healthcare – GoodRx.” The GoodRx Prescription Savings Blog, 15 June 2021, https://www.goodrx.com/blog/the-goodrx-effect-how-goodrx-is-changing-the-economics-of-healthcare/.

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