According to the World Health Organization, people with chronic illness adhere to prescribed medications about 50 percent of the time, a statistic that has stayed constant over many years. What’s even more notable is that medication adherence can have an even greater effect on patient outcomes than the treatment itself. Taking medication as prescribed, or lack thereof, impacts a wide-range of other factors as well, including patient-provider relationships, healthcare costs, health plan performance and Star Ratings, to name a few.

What can health plans and others do to improve compliance and elevate Star Ratings? Here are a few best practices.

Best practices to elevate Star Ratings

  • Build a comprehensive medication adherence program to address the root causes of non-compliance
  • Employ effective patient education with ongoing communication to help members overcome ongoing adherence challenges
  • Use data analytics to uncover non-adherence, such as when members:
    • Start a new medication
    • Do not follow MD recommendations.
  • Match members with those in-the-know including pharmacists, pharmacy techs and nurse practitioners to help uncover specific adherence issues and member concerns
  • Get members actively involved in their own healthcare. With the right Rx data, understand which members require outreach, be specific in your recommendations for cost-effective alternatives and include a call-to-action.
  • Understand the Social Determinants of Health that are preventing members from taking medication as prescribed. These can include, among others: lack of food, limited or no pharmacy access, transportation problems in getting to a physician’s office and health literacy issues.
  • Adapt formulary to support adherence. This could include removing copayments to reduce out of pocket costs. Treatments might be combined (e.g. put member with diabetes on a combined insulin-statin medication) saving on costs and reducing possible side effects, along with the necessity of taking multiple medications.

Whether your members take medication as prescribed or they don’t, you can be sure this behavior is impacting your Star Ratings. These best practices, when put into action can help members improve health and wellbeing, elevate member engagement and ultimately could mean the difference between a half or full point Star Rating.

Learn more about DatabaseRX, the ConnectureDRX solution offering low-cost therapeutic options with the power to improve medication adherence and Star Ratings.

 

Sources:

https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room

https://www.ajmc.com/view/medication-adherence-the-lever-to-improve-medicare-advantage-star-ratings