It’s no secret that the Federal Government is now tracking the performance of healthcare plans. In fact, CMS gauges a health plan’s performance by utilizing a star-rating system. This system not only pushes the bar higher for health plans, encouraging their continued growth toward performance improvement, but also determines whether or not a health plan’s contract with Medicare will continue. And, with their services under such intense scrutiny, those same healthcare plans are pushing pharmacies to assist them in their quest to meet the expectations of this Star Rating system.

How can a pharmacy influence a health plan’s star rating?

By helping to enhance a patient’s health, a pharmacy can have a direct impact on a health plan’s star ratings. In fact, pharmacies that make a patient’s health their top priority, will be in line to receive a higher referral flow and, consequently, higher payments.

Adherence, nonadherence, and customer engagement/organization are measures that can affect star ratings. Pharmacies can help boost a patient’s adherence in several ways. By understanding the barriers patients face and then helping them to remove those barriers to their medication regimens, a pharmacy is able to show a direct collaboration between the providers and their patient. Further, maintaining a high adherence has an effective side-benefit of lowering overall costs (1).

What are some steps a pharmacy can take to boost plan star ratings?

Developing strategies that can help patients appropriately maintain their regimens will go a long way in ensuring a patient increases their chances at maintaining better health, cuts costs associated to the pharmacy and the health plans, and consequently, increases a plan’s ratings with CMS.

Some ways a pharmacy can begin addressing adherence, nonadherence and engagement/organization can include:

Medication simplification

– If a pharmacy can synchronize a patient’s prescriptions to a point where they’re picked up on the same day each month, the pharmacy could see up to a 30% increase in revenue, higher customer satisfaction with the convenience of one-stop-shopping, and higher customer retention due to the level of personalized service.

Identify reasons for the nonadherence

– Obviously, there is no blanket solution to medication nonadherence, however strong customer relationships can be key to understanding barriers to a patient’s ability to adhere to their medication schedule. Forgetfulness, finances, even transportation can all be players in the game of nonadherence and, once identified, these barriers can be addressed and, hopefully, removed.

Organization and strategizing

– Asking the patient some simple questions about how they take their medications can go a long way in helping to understand why, or how, doses can go missed. Questions such as: How do you know you missed a dose? Where do you store your medications? What times of day do you take your medications? – and then offering up suggestions such as pillboxes, keeping medications on counters, etc., can go a long way in helping your patient stay adherent (2).

What it all means

Pharmacists are in a unique and enterprising position that will allow them to build stronger communications and engagement with their customers. Further, independent pharmacists enjoy more exclusively personal, one-on-one relationships with their customer bases. This level of engagement can create more opportunities to shine in ways retail-chain pharmacies simply cannot (3).

This communication and engagement will continue to play a key role in helping to manage medication therapy and allow the pharmacy to play an active role in driving stronger medication adherence levels. And when this occurs, the health plan’s performance will go up, increasing the independent pharmacy’s ability to maintain “preferred provider” status and ensuring continued referrals.

We want to help our members to be successful, so be on the lookout for more insights from our team on how to increase customer engagement!

Sources:

1. http://phrma.org/sites/default/files/pdf/PhRMA_Improving%20Medication%20Adherence_Issue%20Brief.pdf
2. http://www.pharmacytimes.com/news/5-ways-pharmacists-can-improve-medication-adherence
3. http://www.pharmacytimes.com/publications/career/2015/pharmacycareers_february2015/independent-pharmacies-fostering-strong-relationships-with-satisfied-customers

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