Medicare Star measures are used by the Centers for Medicare & Medicaid Services to evaluate the quality of health and prescription plans in the Medicare system. How to leverage data to propel quality, and earn higher Star measures, was the focus of a mid-morning session at Academy of Managed Care Pharmacy (AMCP) Nexus 2024 on Oct. 15.

When a plan achieves a Five Star rating, it becomes a marketing advantage for enrolling members into Medicare Plans, explained Lisanne Holley, clinical pharmacist and program manager at Highmark Health. She also noted there’s a practical matter in earning Stars: if a plan has fewer than three Stars over a period of three years, the contract may be terminated.

“There really needs to be alignment on the importance of the Stars program,” said Sean Wuest, pharmacist account manager at Prime Therapeutics (Prime). “We need to create a culture of quality.” And Prime collaborated with Highmark Health to do just that, with a program to improve statin adherence among members.

As Wuest explained, high performance across the suite of quality domains and measures requires collaboration across multiple teams and appropriate resources, including member support to link members to needed services, such as primary care providers, access to labs and other resources. “It’s about getting the care they need,” he said.

In a poll of attendees, adherence was the quality measure that was most challenging to support in their respective organizations.

“The core of any program is the data analytics team,” Holley said, adding that partners, such as Prime, can help add depth to programs. But partnerships like this shouldn’t have a one-size-fits-all approach, Wuest noted.

“If you’ve seen one health plan, you’ve seen one health plan,” Wuest said. Variables like geographic region and the cultural make-up of membership can impact how a plan can run an effective program. For example, Wuest cited how medication adherence in southern states tends to be lower, which means a plan may need to rethink their approach.

“You need to be mindful of how you target and deploy your resources effectively,” Wuest said.

In the case of a statin program, partner organizations can work with the member to encourage adherence through pharmacists, nurses, care managers and customer care associates. The key is making sure there is a clear goal when engaging with members. In the end, it’s about meeting the member where they are to make sure they have a good experience and achieve a better health outcome, Wuest said.

Newer tools, like Short Message Service (SMS) texting, can drive engagement where a traditional phone call may not, particularly with refill reminders.

“It’s about delivering a message that’s consistent, even down to the look and feel of the material, to drive membership trust and engagement,” Holley said.

Stay tuned for more AMCP Nexus 2024 in focus content throughout the week in the Prime newsroom.