Managing Star-Ratings Through Medication Synchronization

Written By:  Charles D. Shively, PhD, RPh           Chief Executive Healthcare Officer, www. AskDrS.org

How is it patients view and experience the commitment to medication adherence? How can pharmacists ensure commitment to medication adherence by the patient, and further, quantify this commitment?
Today, this can be accomplished using new, sophisticated pharmacy operations software that pinpoints the patient non-adherence impact on the daily Star Ratings report. The ultilization-related metrics are captured in various areas: percentage of days covered, adherence success derived from refill request and pickup, high risk drugs used supporting CMS chronic categories and medication synchronization success.
Unless pharmacies can prove they are completing and documenting the many different pharmacy professional interventions (performing MTM or medication therapy management, using medication synchronization, completing follow-up drug compliance and others), the overall preferred provider performance ratings and subsequent claim reimbursement rates will be impacted…all across the healthcare network.
As we pharmacists know, reimbursement for pharmacy services is moving away from fee for service and becoming part of a value-based patient healthcare payment model endorsed and created by CMS. Our pharmacy services rendered…obviously much more than just prescription filling…will need demonstrate and support measureable improvement to a patient’s condition as part of an integrated clinical partnership. These services are now specific to targeted health prevention and continued conditions or diseases outlined by CMS.
In fact, this payment model has already started in many States. Techniques to identify patients who are underperforming and impact the pharmacy’s Star Rating is now just one “click” away. The steps for the pharmacy to take to improve patient adherence can be quickly identified through extraction of data from the pharmacy system and presented for action on a daily basis in real time, not after the fact.
Importantly, the use of these virtual systems allows pharmacies and pharmacists to understand the impact of patient psychobiological (mind vs. body) traits regarding their medication adherence. One newly designed virtual system (Prescribe Wellness) has demonstrated this ability and is a component of the POCSRx pharmacy operations software.
Is it true the farther we go, we learn how much we really do not know?