AbacusRx

CMS Five-Star

The Center for Medicare and Medicaid Services (CMS) aims to provide better care, healthier people and communities, and lower cost care.In alignment with this goal, CMS developed a one to five star rating system used to evaluate the performance of Medicare Advantage plans. A plan’s star rating is significant because it directly affects their compensation and marketing advantages.

Medicare Advantage plans are rated on performance areas, including outcome measures (improvement in health), intermediate outcome measures, patient experience, access measures (barriers to care), and process measures (how care is provided).

Part D plans are rated on performance measures for four domains: Drug Plan Customer Service, Member Complaints, Problems Getting Services, and Choosing to Leave the Plan, Member Experience with Drug Plan, and Drug Pricing and Patient Safety. The Drug Pricing and Patient Safety domain includes Pharmacy Quality Alliance (PQA)-supported medication adherence measures.

CMS also uses Display Measures to further evaluate Part D plans. Although not included in the plans’ star ratings, these evaluations are reported to CMS and are displayed on the “Patient Safety” website. PQA-supported measures of medication safety, including drug-drug interactions, excessive doses of oral diabetes medications, and completion rate of Comprehensive Medication Reviews, are measured and reported.This is where pharmacies come in!

Data is collected detailing pharmacies’ performance in areas such as vaccinations, health coaching, medication therapy management, health promotion, care coordination, and adherence counseling. Medicare Advantage plans are particularly focused on medication adherence for Part D patients receiving maintenance medications for diseases, such as diabetes, hypertension, and cholesterol.

Pharmacies’ performance evaluations could potentially determine whether a Medicare Advantage plan includes a pharmacy in a preferred network. Plans may seek pharmacies who support their goals and who are willing to work to boost their performance numbers, such as those related to medication adherence.

For pharmacies, this may be a prime opportunity to collaborate with Medicare Advantage plans to improve star ratings and ensure patients are receiving appropriate care. The landscape of healthcare is evolving; in the future, pharmacies will play a growing role in providing comprehensive healthcare to their patients. We recommend you learn more about the CMS star-rating system and how your pharmacy is being evaluated.

Abacus provides monitoring and reporting to assist you in maintaining the highest rating level with the CMS Five-Star.

Read more about the CMS Five-Start rating at:

http://pqaalliance.org/measures/cms.asp