Patient Communications and Star Ratings: Four Must-Have Moves for Improvement

Nov 8, 2018 | Independent Pharmacy Insights, Pharmacy Growth

Star ratings are a direct measurement of health plan performance conducted by the Centers for Medicare and Medicaid (CMS). Indirectly, they’re a measure of how well your pharmacy helps boost a health plan’s performance. And, you can be sure your health plans are watching how your pharmacy contributes to their start ratings. Here are four must-have moves you may want to make to ensure you’re always protecting the quality of your vital health plan relationships.

Patient Communications and Star Ratings: Four Must-Have Moves for Improvement

Technically, there is no “direct” star rating measure for pharmacies. This rating actually is a direct measurement of health plan performance as it relates to the Centers for Medicare and Medicaid (CMS) patient success and sponsored health plans. It’s also a rating system that patients often “eyeball” when making their annual Medicare plan selections. But that doesn’t mean, in terms of Medicare plan star ratings, that health plans are not watching how their preferred pharmacies are indirectly contributing to their start ratings and overall success.

Patient adherence is a key element that CMS sponsored plans are looking at to establish and renew preferred pharmacy contracts. Here are some tips to ensure your patients continue to not only remain adherent to care plans but play an active role in achieving target outcomes and keeping their CMS sponsored health plan related per-patient costs ($950 – $44,190 a year) in control.

1. Understanding the CMS MTM Requirement

A medication therapy management (MTM) strategy is something CMS requires to protect its beneficiaries and its bottom line. According to, MTM plans must fulfill the following requirements:

  • Ensure optimum therapeutic outcomes for targeted beneficiaries through improved medication use
  • Reduce the risk of adverse events
  • Is developed in cooperation with licensed and practicing pharmacists and physicians
  • Describes the resources and time required to implement the program if using outside personnel and establishes the fees for pharmacists or others
  • May be furnished by pharmacists or other qualified providers
  • May distinguish between services in ambulatory and institutional settings
  • Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)

2. Put in Place Your MTM Strategy and Boost It with Relatable Patient Information

Your patients are unique, as are the ways to motivate them toward adherence. Everyone wants to “get better,” but if “getting better” becomes too complicated or cumbersome, patients will drop out. You can help reduce costly (health and financial) dropouts by sharing the relatable experiences of other patients successfully dealing with similar circumstances (while maintaining HIPAA-required patient privacy). Share de-identified patient stories, their challenges, and their successes in managing specific care plans through social media or other digital mediums: targeted emails, blogs, and text notifications that lead to this information. Patients will relate to the struggles of those who came before them and may be more likely to persevere through even the most taxing care plans. Turn to medication manufacturers for success stories if you must, but make sure to let your patients know that better adherence = better outcomes.

3. Patient Adherence Apps

Patients are closer to their personal technology than most other people, suggest researchers. So why not fill the adherence gap through personal technology? Text messaging has become the new conversation for most people. According to a recent study, Medicare patients who received a text message about their therapy had a 14.1% higher refill rate versus those who did not. So, technology and apps are not age-exclusive and are known to boost Medicare adherence, according to observational studies.

4. Coaching can Work when Tech Efforts Miss the Mark

When all other strategies fall short in improving patient adherence, pharmacies and health plans can take other collaborative measures to “coach” patients into success.

Healthcare coaching enables pharmacies to create a truly patient-centered experience that is unique to each individual healthcare consumer. Instead of asking a patient to make specific technologies fit into their lifestyle, healthcare coaching takes a look at that patient’s lifestyle and determines what interventions will complement it for a better chance at a successful outcome. Coaching includes top-notch pharmacy communication skills, open-ended questions for the patient and about their unique situation, and proven patient motivation techniques to help drive adherence.

The pharmacy coach needs to be equipped to learn what patients already know about their diagnoses, their readiness to commit to care plans, and their abilities to commit to behavior changes, if required.

From there, coaches must be trained to motivate patients to pursue their “healthiest lives” through the care plan and medication, and nudge patients toward making these “success breakthroughs” at their own pace, educate, and make further adjustments as necessary. Recent studies reported that patients who receive coaching from their providers can show up to a seven percent improvement in medication adherence. That’s no small feat with resistant patients.

At the end of the day, it’s all about the communications. If you can do this, you have a better chance at boosting the CMS star ratings of your contract providers and your opportunities to help their patients succeed in the future as a preferred pharmacy.

Closing Thoughts

Boosting your patient adherence (and associated health plan CMS star ratings) isn’t rocket science. It’s based on communicating to your patient what you already do best: guide them through therapy management. So, use these tips to build or enhance your strategy to drive adherence and your pharmacy’s ability to help health plans do better by their patients according to CMS standards.

How will your community pharmacy communicate with patients to improve adherence and, ultimately, star ratings? Has your pharmacy tapped the secret to successful patient adherence? Have you used any of these strategies? Have you found a particular strategy or tip that works better than another? We’d love to know and may even share those experiences in future blog posts, white papers, and e-books. If you’d like to add your experience, please contact Jessica Gardner.

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