- Medication adherence is key to chronic disease management and is also a Medicare 5 STAR performance quality measure for certain medication classes treating diabetes, hypertension, and cholesterol.
- The Medication Adherence initiative is a pilot by Affinia Health Network which will see a full go-live in 2021.
- Within the Medication Adherence pilot, a team of pharmacy technicians, trained to interview and assess the patient’s medication use history and provide education on the importance of using medications as prescribed, will perform medication adherence outreach calls. This team will refer to a care manager, pharmacist, or the patient’s primary care provider as needed.
A medication adherence assessment can help healthcare providers understand how the patient is taking their medications and help to find out if the patient needs more information or support related to medication use. Affinia Health Network identified medication adherence as an opportunity to assist with patient care at a population health level. It is important to improve medication adherence for diabetes, cholesterol, and antihypertensive medications since these medications have been proven to show long-term improvement in mortality outcomes. Additionally, medication adherence is a Medicare 5 STAR performance quality measure.1,2
The Medication Adherence initiative performed a soft roll out in 2020 and will perform full roll out of the 2021 pilot with focus on eligible patients within the Blue Cross Blue Shield and Priority Health Medicare Advantage plans.
Within this initiative, a team of pharmacy technicians will perform all outreach calls. This team, is trained to interview and assess the patient’s medication use history, provide education on the importance of using medications as prescribed, and refer to a care manager, pharmacist, or the patient’s primary care provider as needed. All medication adherence assessments will be documented in the patient’s chart and each encounter is provided at no cost for all patients.
Medication Adherence Assessment Eligibility
The Medication Adherence initiative focuses on certain Blue Cross Blue Shield and Priority Health Medicare Advantage contracts. In order to qualify, patients must:
- Be 18 years or older
- Be taking a targeted medication
- Have filled at least 2 prescriptions of a targeted medication but also have a proportion of days covered less than 80%
The Future of Medication Adherence Services
Our initial focus will be on Blue Cross Blue Shield and Priority Health Medicare Advantage contracts. The team will be closely monitoring progress, performance, and outcomes of the program to determine how best to perform these services. Affinia has an ultimate goal of expanding participation beyond the currently focused contracts.
- PQA Alliance. Frequently Asked Questions for PQA Measures in the Health Insurance Marketplace Quality Rating System. Available at: https://www.pqaalliance.org/assets/Measures/QRS%20Measures%20FAQs%2020200403.pdf.
- Centers for Medicare & Medicaid Services. 2020 Quality Rating System Measure Technical Specifications. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/2020-QRS-Measure-Tech-Specs_20190925_508.pdf.