Every October, the Centers for Medicare and Medicaid Services (CMS) publish an update to the Star Ratings for Medicare Part C & D plans. This update serves as an annual “check-up” on how well the Medicare program is working to improve quality of care for the millions of enrollees in the program. Like reviews in any type of industry, changes can be swift and sudden. On the other hand, some programs move steadily along – be it in either a positive or negative manner.

So, what did the 2020 Star Ratings Technical notes tell us? To put it simply, the program is continuing to grow and improve care for Medicare beneficiaries. The average overall Star Rating for the Medicare Advantage program increased to 4.16 (on a scale up to 5). This represents the largest increase for the program in the last three years. Standalone prescription drug plans (PDPs), increased to a new average score of 3.5 Stars.

These improvements in Star Ratings represent an industry-wide focus on improving patient care. As Medicare beneficiaries review their Medicare plan options during this open enrollment season (Oct. 15-Dec 7), the Star Ratings for their plan options are easily identifiable and provide a simple starting point for beneficiaries to review. The Star Ratings include many elements of the care continuum for patients, but the measures most applicable to the pharmacy marketplace focus on medication-related quality measures. For many years, even before the Star Ratings existed, pharmacists have often touted their capabilities to optimize a patient’s medication regimen, improve medication adherence and provide numerous health screenings and services that can improve patient care.

For the 2020 Star Ratings, labeled as such due to the calendar year the plans will be covering, the below bullet points detail the performance of health plans that will be offered next year.

• The average score for the medication adherence measures (Cholesterol PDC, Diabetes PDC, and RASA PDC) increased for both MAPD and PDP plans. Initiatives to improve medication adherence for the Medicare population continue to improve as well! A Medication adherence should be a necessary focus for many years to come.
• There are changes to measure details, including some medications that are excluded for these measures and some exclusions related to disease states (End Stage Renal Disease). This is another important item to note, as reviews for the appropriateness of quality measures are reviewed. Understanding and educating teams about the measures remain to be an important consideration.
• Improvements are also evident for the MTM Program Completion Rate for Comprehensive Medication Review! Pharmacists are an incredibly accessible healthcare provider and remain the medication expert, thus continuing to deliver positive outcomes through medication reviews.

Going forward, opportunities for pharmacists to be further involved with the patient care process will increase and be necessary. Improvements for these medication-related quality measures are largely driven by the pharmacist-patient relationship and the extraordinary knowledge on medications that pharmacists possess. Pharmacists should continue to grow and expand their patient services and talk with their patients about the what they uniquely provide. Similarly, pharmacists should consider how they can work with local prescribers, health systems, health plans and even employer groups. Your unique ability, patient care approach and frequency of patient touch points as a pharmacist has untapped potential to improve health outcomes. Think creatively about how you can grow these opportunities and continue to network with other pharmacists so that you can improve patient care and elevate the profession of pharmacy.

For more information about quality improvement resources, we encourage you to check out the “Resources” tab in EQuIPP™. In particular, we recommend watching our video series which easily helps to explain quality measures and how you can use EQuIPP™ to track the progress of your improvement opportunities. These videos are also available on the Pharmacy Quality Solutions website.

https://pharmacyquality.com/pqs-videos/

Also check out the PQS Summary of the 2020 Medicare Part C and D Star Ratings Technical Notes.

For more questions on quality, please contact us at [email protected].