- Many payers use CMS Performance Measures and STAR ratings to provide incentives to increase quality of care. Medication adherence is one of the performance measures that is monitored.
- Implementation of this initiative will increase quality of care with the additional bonus of increasing our performance measures and STAR ratings.
- A new Medication Adherence Initiative facilitated by Affinia Health Network will soon be in action to support this measure.
The Centers for Medicare and Medicaid Services (CMS) sets certain quality measures as a method to assess overall healthcare outcomes and provide quality care to patients. These quality measures are assessed in health systems across the country. Some examples of these measures include: Care Coordination, Patient Safety, Efficient Use of Healthcare Resources, and more.1
Affinia Health Network is currently starting an initiative to focus on the quality measure Medication Adherence. Eligible patients for the measure include those who are 18 years or older, have filled a targeted medication at least twice in one calendar year, and those who’s proportion of medication days covered was less than <80% of the time period. The <80% adherence is calculated by third party payers by analyzing claims data. Currently, Affinia Health Network will be offering this service for eligible Blue Cross Blue Shield (BCBS) Medicare Advantage PPO patients, however this initiative may grow to cover other payer systems as well.
What medications are included in this measure?
- Select diabetes medications (excluding insulin products)
- Select cholesterol medications (statin medications)
- Select hypertension medications
Initiation of the Program
For Affinia Health Network’s Medication Adherence Initiative, the process begins with analysis of data provided by BCBS on potentially non-adherent patients. The Affinia pharmacy technician team will outreach to these patients and record encounters in EPIC. In order to assess for medication adherence, there are many tools/methods that may be used. One of the most commonly used tools is the Drug Adherence Work-up (DRAW) tool.2 To view an example of the DRAW tool questionnaire please refer to https://secure.outcomesmtm.com/secureSite/resources/docs/DRAW.pdf. This tool helps identify drivers of non-adherence to medications and next steps to help the patient become more adherent with their medications. The main goal with this program is to increase the quality of care our patients receive by providing tips and tools to improve their overall medication adherence and there will be no cost to the patient.
As the initiative is in beginning stages, Affinia Health Network will be working to optimize the program design. The goal is to create an optimal workflow to reach the most patients and provide the best quality outcomes. Go-live of the Medication Adherence Initiative for the pilot population will occur in summer 2020.
- Five-Star Quality Rating System | CMS. Accessed May 29, 2020. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS
- Doucette WR, Farris KB, Youland KM, Newland BA, Egerton SJ, Barnes JM. Development of the Drug Adherence Work-up (DRAW) tool. Journal of the American Pharmacists Association. 2012;52(6):e199-e204. doi:10.1331/JAPhA.2012.12001