A Member-Directed Medication Adherence Intervention

San Diego—Engaging patients and improving medication adherence was the aim of a program implemented in a population of dual-eligible special needs Medicare Advantage (MA) beneficiaries. The program involved the cooperation of a MA plan (iCare), a pharmacy benefit manager (MedImpact HealthCare Systems, Inc.), and a mail-order pharmacy (United States Medical Supply [US MED]).

At a Pharmacy Partnership Benefits session at the AMCP meeting, the program and results were presented. The session was titled An Integrated Adherence Program Aimed to Increase Medicare Part D Star Rating Measures. The session opened with a slide outlining the importance of medication adherence, noting that according to the World Health Organization, the cost of nonadherence is approximately $188 billion annually.

Breanne Tirado, PharmD, director of pharmacy services at iCare, began by identifying the challenges presented by iCare’s population. The plan was formed in 1994 as a demonstration plan to provide managed care services to people with disabilities. It includes 5000 dual-eligible special needs members who fill an average of 5.24 prescriptions each month. The members are often transient, low-income, <65 years of age, and afflicted with mental illness and/or addiction. Achieving Medicare Star Ratings to qualify for the Centers for Medicare & Medicaid Services (CMS) bonus payment is extremely important to the plan, Dr. Tirado said.

She said that iCare’s objective was to increase adherence for the plan’s beneficiaries who were taking medications in at least 1 of 3 target drug categories (oral diabetes medications, medications for hypertension [renin angiotensin system antagonists], and medications to control cholesterol [statins]). The success measures were improving patient adherence in those 3 CMS medication adherence Star Ratings and becoming a 5-Star health plan earning the maximum CMS bonus payment.

The session continued with a description of the medication adherence program implemented at iCare provided by Philip Rein, regional director, and R. Scott Leslie, MPH, health outcomes researcher, at MedImpact HealthCare Systems, Inc., and James Bailey, director of managed care sales and contracting, US MED. The program included 5 components: (1) member identification and stratification (MedImpact); (2) data formatting and packaging (MedImpact); (3) data upload to care management system and outreach (iCare); (4) engagement and fulfillment (US MED); and (5) performance evaluation (MedImpact).

MedImpact identified the targeted members based on utilization of the targeted medication categories and used CMS technical guidance to identify members with proportion of days covered <80%. The list of targeted members was further stratified based on additional criteria, including newly initiated therapy and a 6-month rolling look-back.

The major data points packaged and sent to iCare and US MED included member information, drug category, and adherence rate. The data were uploaded into TruCare^™, iCare’s care management system. Coordinators then implemented the outreach component of the program, including outreach using a care manger and targeted mailings, engaged members and their physicians, encouraged patients to utilize US MED mail-order prescription fulfillment, reported intervention data, and sent surveys to measure member satisfaction.

The methods used to determine adherence followed the CMS Technical Notes and Acumen Report User Guide (October 2012). Adherence was measured as proportion of days covered for the 3 targeted medications. Rates of adherence were weighted by members’ length of enrollment.

After implementation of the iCare program, the adherence rate for patients utilizing US MED for D16 (oral diabetes) medications was 82.8% (D16 5-Star Rating requirement is 79.0%); for D17 (hypertension), the US MED rate was 82.4% (D17 5-Star Rating requirement is 79.7%); for D18 (cholesterol), the US MED rate was 79.9% (D18 5-Star Rating requirement is 75.4%).

In conclusion, the speakers said that communication and engagement of all stakeholders are critical to the success of a program to increase adherence: clients, members, and providers were all engaged and involved in the program, contributing to its success.