Medication Adherence as a Path to Unlock Savings Opportunities

In a post COVID-19 world, it’s more critical than ever for health plans to gain market share as well as decrease costs associated with poor outcomes. By achieving the 5 star rating in the Star Rating Program, Medicare Advantage prescription drug plans and stand-alone prescription drug plans are able to enroll members throughout the calendar year compared to those plans who are only allowed to enroll members through open enrollment. By achieving the higher rating, these plans are also subject to a bonus payment of around 5%. One way to achieve the higher rating is to focus on the triple weighted medication adherence measures. Plans can enroll in the AB2D program to receive the Medicare Part A and B claims for their enrollees which will help them to better track medication adherence and control their overall costs and outcomes.

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FAQ

Q: How is "non-adherence" defined in this analysis? 

A: Non-adherence is defined as <75% medication adherence. 

Q: How do you define the savings opportunity?

A: Savings Opportunity is the % change in PMPY by moving from non-adherent to adherent.  

Q: What methodology are you using to define chronic conditions?

A: Beneficiaries are defined as having a particular chronic condition according to the CMS Chronic Conditions Data Warehouse. 

Q: This is cut by geography but I would like to see these roll-ups at my plan level.  What can I do?

A: Please reach out to your main CareJourney contact to learn more.  If you do not have a main point of contact, please email jumpstart@carejourney.com.  

Q: How are patients segmented by frailty in this analysis? 

A: We leveraged a Medicare high need, high cost patient segmentation model created by Ashish Jha and team at the Harvard School of Public Health. [1]

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Questions?

If you’re interested in better understanding AB2D, CMS Star Rating Program, med adherence and savings opportunities of other chronic conditions, we want to hear from you! CareJourney can help by looking deeper to explore your organization’s patient population, patients in specific geographies or sub-cohorts of interest, as well as provider performance in treating these patient populations.

Should you have any additional questions, please reach out to your main point of contact at CareJourney for more information and/or additional support regarding this analysis. If you do not have a main point of contact at CareJourney, please reach out to jumpstart@carejourney.com

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About CareJourney

CareJourney is a leading provider of clinically-relevant analytics for value-based networks supporting leading payer, provider, and life sciences organizations across the US. We help these organizations achieve their goals by bringing new, high value insights out of expansive population claims data.

References

[1] Joynt KE, Figueroa JF, Beaulieu N, Wild RC, Orav EJ, Jha AK. Segmenting high-cost Medicare patients into potentially actionable cohorts. Healthc (Amst). 2017;5(1-2):62‐67. doi:10.1016/j.hjdsi.2016.11.002