August 1, 2016 - Curant Health COO, Marc O'Connor, in Managed Healthcare Executive - The Centers for Medicare and Medicaid Services (CMS) implemented the Five Star Quality Rating System to help educate consumers on quality of healthcare and make healthcare quality data more transparent. Health plans are rated on multiple measures, five of which are specifically related to medication management and the pharmacy: high-risk medications, diabetes treatment, medication adherence for diabetes, adherence for hypertension and adherence for cholesterol. Currently, these five measures account for almost half of a plan’s total score from CMS.
CMS does not issue Star Ratings for pharmacies, only for health plans. However, the plans can assess how their network pharmacies meet medication management and adherence measures by simply reviewing claims. Regular claims for prescription coverage by patients, especially refills, is a leading proxy for compliance or “adherence,” which leads to better health outcomes. This allows plans to issue their own ratings for pharmacies and to evaluate those that better meet CMS-defined quality measures. To increase their own Star Rating, health plans can rework their preferred networks to include only pharmacies with high ratings on medication-related measures.
Medications flagged as being high-risk for the elderly are included on the PQA High-Risk Medications (HRM) measure drug list, which is based on recommendations from the American Geriatrics Society (AGS). Inappropriate use of these medications can lead adverse drug events (ADEs), the leading cause of hospital admissions. One study has shown that 30% of hospital admissions of elderly patients may be linked to drug-related problems and another study has shown that 35% of ambulatory older adults experienced an ADE and 29% required healthcare services.
To read Marc’s full article, visit Managed Healthcare Executive.
To learn more about Curant Health, contact Kristin Lindsey, Senior Marketing Director, at klindsey@curanthealth.com.