We all know that adherence to prescriptions is a problem. People don’t start on their medications. People don’t stay on their medications. But, another problem also exists which is finding the ROI on adherence. While the ROI is clear to the manufacturer or even to the pharmacy, it’s often less clear to the payer.
This is not true in every category. Diabetes and several other conditions have been shown to have an ROI associated with intervention programs that improve adherence. But what about all the others.
In the short-term, I expect you’ll see the CMS Star Ratings and bonus payments drive behavior in three critical categories that are now measured in the 2012 for MAPD and PDP plans. (see technical notes on 2012 measures)
If you’re not familiar with the Star Ratings system, you should read this. In 2012, there were three new adherence measures added. Not only are they now part of the evaluation process, but they were weighted more heavily than some of the operational measures. A good indication of focus on quality of care.
Getting more Stars is important since it is linked to bonus dollars that the plans can get. And, there aren’t many Five Star Plans. Only 9 plans received 5-Star Ratings for 2012 (see article). [Interestingly, I think one of the unique assets that Express Scripts is buying in the proposed Medco acquisition is one of the 4 Five-Star PDP plans.]
“The Medicare star quality rating system encourages health plans to improve care and service, leading to better patient experiences across the board,” Jed Weissberg, a senior vice president at Kaiser Permanente. (from 5-star article above)
The adherence measures focus on diabetes, high cholesterol, and hypertension and use Proportion of Days Covered (PDC) rather than MPR for their measurement. Certainly, one of the things we’re seeing at Silverlink with our Star Power program is that many of these Star Measures can be influenced by communications. Adherence is certainly one of those big areas of opportunity for plans to focus on.
While the benefit is obvious to the plan in terms of reimbursement, the big question is whether consumers care about Star Ratings or just focus on lowest price point and access to pharmacies or specific medications. A Kaiser study that was done seems to indicate that the answer is no.
Conducted by Harris Interactive, the survey showed that only 18 percent of Medicare-eligible seniors said that they are familiar with the government’s rating system. Of those that are familiar, less than one-third have used the system to select their health plan. Moreover, only 2 percent of respondents were aware of how their current plans rates.
Since we’re in open enrollment for Medicare right now (see Medicare.gov to evaluate options), perhaps we’ll get some data in early 2012. 2012 will also be the first year for the 5-Star plans to be able to market all year round and not be limited to the OEP (open enrollment period).
But, one of the things I found interesting as I looked on the Medicare.gov site to “select” a plan in my area is that there is an option to “Select Plan Ratings” but even I wasn’t sure what that was. It’s not intuitive to the consumer that this is a quality rating for them to pay attention to. And, it appears that the default order of options which is presented to you is based on price.
October 31, 2011 
Enabling Healthy Decisions 