In an effort to improve performance for a 14,000-member Medicare plan in the Centers for Medicare & Medicaid Services (CMS) Star diabetes, RAS antagonists and statins adherence measures, Prime Therapeutics (Prime) collaborated on the development and implementation of a pharmacist-led clinical program. Results from this program are slated to be shared at the Academy of Managed Care Pharmacy (AMCP) Nexus event in Las Vegas, Nevada. 
  
Outreach is primarily made through pharmacist-led phone calls with supplemental Short Message Service (SMS), and 1 out of 4 plan members speak Spanish. To improve performance for the Star adherence measure and promote health equity, SMS outreach was translated for Spanish-speaking members in addition to the use of interpreter services for live calls. As a result, SMS participation among Spanish-speaking members increased 9% from 2022 to 2023, which led to improved engagement during live calls, 90-day supply conversion rates, and treatment rates. Overall, translation efforts led to an increase in performance across all three Star measures among the Spanish-speaking population (by up to 4.3%) as well as the overall population (by up to 3.7%).   

I (Alex Cook, part of Prime's newsroom team) met up with Nicole Grevenitz, director of clinical account services at Prime, to learn more about this study and its implications. 

Alex Cook: Thank you for taking time during this busy week at AMCP Nexus. Taking a step back, explain what Star measures are and why they are so important.
Nicole Grevenitz: The CMS implemented a Five-Star Quality Rating System to drive quality improvement for Medicare beneficiaries.  The Star Ratings system is based on a scale of 1–5  and measures the quality of services received by beneficiaries. Results are published for review on the Medicare Plan Finder website. This information helps members compare the quality of plans, evaluate their options and determine which plan may best suit their health care needs. Medicare plans strive to achieve high performance not only for the benefit of their members, but also due to bonus payments paid out by CMS to plans that receive four or more Stars.

It seems like such a simple thing to translate communications to see an improvement in engagement. But you also saw downstream benefits. How do you explain that?
Members want to feel heard and understood. They acknowledged that we took the time to meet their needs and were appreciative of that. Therefore, their willingness to collaborate and engage with us increased. Furthermore, being able to more effectively communicate with members helped our pharmacists uncover and address barriers to adherence that may have flown under the radar if there were language limitations in play, ultimately impacting overall health.   

What can the managed care pharmacy space learn from this study, particularly as access to care is a core mission of AMCP?
Meeting member needs is beneficial to all parties. Not only can improving access to care positively impact the member experience, but it can also positively influence the ownership and actions taken by the member in their health care journey.

As you look at the topic of health equity, what are some other areas of study that interest you as you look into the future? 
Consistent, equal access to quality health care for all will continue to be an important focus. We are working with our health plan partners to improve access to care with initiatives such as transportation services to and from providers and pharmacies, one-on-one case manager coordination to address specific member needs and in-home visits for members where that may be a necessity. Expanding services such as pill packaging for members with complex medication regimens to ease disease burden and improve adherence is also an area of interest.  

Look out for additional AMCP Nexus 2024 in focus content all week long in the Prime newsroom. For more on this research, check out the research poster.