Improving Part D Star Ratings through Collaboration

San Diego—The Centers for Medicare & Medicaid Services (CMS) Star Ratings program has heightened plan sponsors’ attention for the need to improve medication adherence and other aspects of medication use. As a result, plans will continue to have increased accountability associated with medication use quality measure performance. Pharmacies and pharmacists are well-positioned to be key partners in strategies aimed at improving the quality of medication use.

During a Contemporary Issues session at the AMCP meeting, Mark Conklin, PharmD, MS, Jesse McCullough, PharmD, and Linda Kobilarcsik, RPh, addressed the growing attention paid to quality measures and the need to manage performance information to facilitate new collaborative models in a presentation titled Partnering for Quality: Improving Part D Stars through Plan-Pharmacy Collaboration.

The Star Rating system is a set of >40 quality measures defined by CMS to rate and rank Medicare Advantage Plans and prescription drug plans. Each measure is rated on a scale of 1 to 5.

Dr. Conklin, vice president of operations at Pharmacy Quality Solutions, explained that Medicare drug plans receive a summary rating on quality as well as on 4 domain and individual measure scores (18 individual measures in total). He also made a case for collaboration in improving quality and performance, noting that pharmacy has been conspicuously absent from value-based discussions, yet represents an untapped source of improvement; not all adherence barriers can be addressed using current improvement tactics; and there is a need to connect the value all the way through the chain.

Dr. McCullough, director, field clinical services for Rite Aid Pharmacy, discussed the role of pharmacists in improving patient care and efforts by Rite Aid. The chain has implemented a multiyear plan focusing on data collections, technology, training, and workflow to improve performance, he said. The Rite Care Prescription Advisor program is one example. Rite Aid developed this tool to help pharmacists drive more effective interventions related to medication compliance. Rite Aid pharmacists can provide personalized reports that show how well patients are following their prescription drug regimens. The report gives a compliance score for each prescription.

Another way Rite Aid is helping deliver more clinically oriented services is having pharmacists certified to provide immunizations. To date, Rite Aid has 11,500 immunizing pharmacists and offers all vaccines, as allowed by each state, according to Dr. McCullough. The pharmacy chain is also looking at strategies to improve workflow, which will allow pharmacists more time for face-to-face counseling with patients. Rite Aid is incorporating more pharmacy technician support and training, making improvements with dispensing systems, and evaluating new dispensing models.

During the final presentation, Ms. Kobilarcsik, senior director, clinical pharmacy programs at UnitedHealthcare, discussed improving opioid medication use in the Medicare Part D population. In September 2011, the Government Accountability Office (GAO) published the Medicare Part D: Instance of Questionable Access to Prescription Drugs report. The GAO found indications of “doctor shopping” in 14 categories of frequently abused prescriptions drugs. Hydrocodone and oxycodone were the most prevalent drugs prescribed by multiple prescribers, representing 80% of the identified instances of doctor shopping.

The GAO recommended that CMS consider controls to reduce doctor shopping, explained Ms. Kobilarcsik. In its 2013 Call Letter, CMS outlined measures to improve opioid medication use. For example, Part D plan sponsors are responsible for identifying potential medication overutilization and to engage prescribers. Plan efforts can include using a central data repository to identify beneficiaries receiving opioid medications from multiple prescribers and pharmacies.

CMS requires Part D plans to develop effective retrospective drug utilization review programs that include case management.