Engaging the Community Pharmacy Team in Medicare Star Ratings Mitzi Wasik, PharmD, BCPS Director,...
-
Upload
madeline-marshall -
Category
Documents
-
view
216 -
download
0
Transcript of Engaging the Community Pharmacy Team in Medicare Star Ratings Mitzi Wasik, PharmD, BCPS Director,...
Engaging the Community Pharmacy Team in Medicare
Star RatingsMitzi Wasik, PharmD, BCPS
Director, Government Pharmacy Programs
October 24th, 2013
Participation: asking questions and answering polls Slide handout is available via “event resources” in the
lower left of the screen Process for CE credit – view entire program and
complete evaluation For assistance with technical problems click on the
question mark in the right corner of the screen
Program Logistics
Support This lesson is supported by an education
grant from Voice Port
Mitzi Wasik and the DSN Continuing Education team do not have any actual or potential conflicts of interest in relation to this CE activity
Disclosures
Objectives
Explain the Medicare Star ratings’ metrics related to the pharmacy benefit
Describe how Star ratings impact Medicare reimbursement
Identify changes to the Medicare Star ratings in 2013 Evaluate the engagement of consumer’s awareness
of Medicare Star ratings Formulate a method to support the Star ratings in
community practice
Why STARS Ratings?
Quality driven healthcare
Push for value and quality in the healthcare
system
Putting the patient first
Overall goal: Improving value and quality while
decreasing costs
Medicare Ratings-Part D
Patient Safety Measures (PSM) have been adapted from PQA (Pharmacy Quality Alliance)
The 5 triple weighted Patient Safety Measures have all been adapted from PQA
HEDIS Consumer Assessment of Healthcare Providers and
Systems survey (CAHPS) Health of Seniors survey (HOS)
PDP and MA-PD Medicare plans are rated on overall on quality Includes 4 domain scores with 15 individual measures
The first year a measure is included, it is weighted as a “1” The next year the weight may be adjusted
Measures are weighted 1x, 1.5x, or 3x Weight is dependent on category All 5 Patient Safety Measures are 3x weightAll 5 Patient Safety Measures are 3x weight
For PDPs these measures account for ~30% of overall rating For MA-PDs these measures account for 20% of overall rating
Medicare Ratings – Part D
Ratings range from 1 to 5 5 is the goal, 1 is not!
Plans that perform overall less than 3 for 3 consecutive years are at risk for losing their contract
If a plan receives < 3 stars There is an indicator online to alert the beneficiary Beneficiaries may not enroll in these plans online,
enrollment must be done via phone Enrollment in 5 star plans can occur at any time
(rolling AEP)
STAR Ratings
STAR Ratings
PDP and MAPD are rated on separate curves Each contract is individually rated on an overall
score as well as individual scores per measure The curves are set from a national perspective
There is no regional adjustment For Part D Patient Safety 4 Star Thresholds have
been given for 4 of 5 measures (new in 2013)
Display Measures (not included in annual ratings reported to members) are also included in CMS review
2013 current patient safety display measures are Drug-drug Interactions Excessive doses of oral diabetes medications Comprehensive Medication Reviews (CMRs) Adherence to antiretroviral meds
Not an official display measure but currently tracked by CMS Increases PDC (proportion of days covered) to 90%
2014 some Star measures being removed to display page: Enrollment timeliness Getting information from drug plans Call center pharmacy hold times
Display Measures
New Display Measures for 2014
Part C Pharmacotherapy Management of COPD Exacerbation
(PCE) * Initiation and Engagement of Alcohol and Other Drug
Dependence Treatment (IET) HEDIS Scores for Low Enrollment Contracts
Part D Variation of MPF Price Accuracy
* Moves from display measure to measure in 2015
New Display Measures
Pharmacotherapy management of COPD exacerbations (PCE) for Part C for display in 2014 and inclusion in 2015
Percent of COPD exacerbations for members age 40 or older who had an acute inpatient discharge or ER encounter
Dispensed a systemic steroid within 14 days and Dispensed a bronchodilator within 30 days
MTM Program completion rate for CMR for Part D 2014 display measure 2015 possible inclusion
Medicare Ratings 2014
CMS Star Rating Fact Sheet, October 2013
2014 Part D Measures
Call Center – Foreign Language and TTY Appeals Auto-Forward Appeals Upheld Complaints about the Drug Plan Beneficiary Access and Performance Problems Members Choosing to Leave the Plan Drug Plan Quality Improvement Rating of Drug Plan Getting Needed Prescription Drugs MPF Price Accuracy
The Low Hanging Fruit for Pharmacy!
The Five Triple Weighted Patient Safety Measures
New measures receive a weight of “1” in the first
year, and then assigned the weight per their
weighting categories
Weighted Measures
Triple Weighted Patient Safety Measures High Risk Medications (HRMs) - based on PQA list of high risk
medications 60 medications as well as oral/transdermal estrogen products 5 agents with parameters other than 2 fills (dosage, >90 days of
use) Diabetic Treatment
1 fill of an oral anti-diabetic drug or insulin and a calcium channel block or beta-blocker and on and ACE/ARB/DRI
3 Adherence Drug Classes- Anti-diabetic drugs, RASA (renin-angiotensin-receptor antagonists) and statins 2 fills of one drugs in above class Goal of 80% Proportion of Days Covered (PDC)
ACE-Angiotensin Converting Enzyme Inhibitor, ARB-Angiotensin Receptor Blocker, DRI-Direct Renin Inhibitor
Current Pharmacy STARS Measurements
20
High Risk Medications (HRM) Based on 2 fills of same HRM Meds pulled from PQA supported list derived from the
Inappropriate Medication Use in the Elderly (referred to as Beers list) Prior to 4/12, the last update to Beers was 2002 Now published by the American Geriatrics Society Sample of meds included in the HRM measure
cyclobenzaprine, carisoprodol, conjugated estrogens, nitrofurantoin, antihistamines, antiemetics, etc
Published April 2012 with American Geriatric Society Website has many resources for providers and patients
***Pocket cards for providers*** App available for free
Important additions Glyburide – renal insufficiency caution Digoxin > 0.125mg average daily dose Non-benzo hypnotics > 90 days
Deletions Older drugs that are no longer in use Daily fluoxetine
BEERS/PQA Update
Difficult to measure to manage Removal of drugs, utilization management Cannot remove patient from the numerator after 2
fills Current National Averages (through 7/13/13)
MAPD – 7.78% PDP – 10.17%
High Risk Medications
Diabetic Treatment Any patient that has 1 or more fill or an oral diabetes
medication or insulin as well as to a beta blocker or
calcium channel blocker are included in the measure
The measure assesses how many of these patients
are also on an ACE/ARB/DRI
Only requires one fill!
Current Pharmacy STARS Measurements
Current Pharmacy STARS Measurements
Barriers
Cash Claims
Many plans struggle with this measure
Coordination of care
Opportunity?
Current Pharmacy STARS Measurements 25
Adherence Patients with 2 or more fills of an adherence medication
fall into the measure
Current measures include 3 drug class
ACE/ARB/DRI’s, Statins, Diabetes Medications (except
insulin)
Updated in 2012 to include inpatient hospital stays
Goal is 80% adherence calculated by PDC
Proportion of Days Covered (PDC) vs. Medication Possession Ratio (MPR)
MPR tends to overestimate true adherence
Does not have safety nets built in for early fills,
duplication in therapy classes, etc.
PDC is a more sophisticated measurement to
account for days supply on hand, and above issues
http://www.pqaalliance.org/images/uploads/files/PQA%20PDC%20vs%20%20MPR.pdf
In your current practice, what do you routinely check during the quality assurance process? A. I only check the prescription for safety and accuracy B. I review the profile at each fill (new and refills) to ensure all necessary medications are being taken C. I check the profile for gaps in therapy when dispensing new prescriptions
Self-Assessment Polling Question 1
In your current practice, what do you routinely check during the quality assurance process? A. I only check the prescription for safety and accuracy B. I review the profile at each fill (new and refills) to ensure all necessary medications are being taken C. I check the profile for gaps in therapy when dispensing new prescriptions
Self-Assessment Polling Question 1
Mrs. Curry, 66 year old female, presents to your pharmacy for a refill on her glyburide
She has no new complaints and reports she is doing well per today’s doctor check up
Her current medication list consists of 4 meds: Glyburide Metformin Metoprolol Keflex
Patient Discussion – Applying Skills
What medication(s) should the pharmacist consider recommending to Mrs. Curry’s prescriber to be considered for addition to her medication regimen? A. NoneB. Aspirin, ACE/ARB/DRI and Statin C. ACE/ARB/DRID. Insulin
Case Discussion Polling Question 2
What medication(s) should the pharmacist consider recommending to Mrs. Curry’s prescriber to be considered for addition to her medication regimen? A. NoneB. Aspirin, ACE/ARB/DRI and Statin C. ACE/ARB/DRID. Insulin
Case Discussion Polling Question 2
New Cut Points Released for 2014 STARS (based on 2012 data)! 2nd preview period was sent to plans on 9/4 5 Star cut points (compared with previous year):
2013 2014PDC-Diabetes 79.0 % 77 %
PDC - RASA 79.7 % 79 %
PDC - Statins 75.4 % 75 %
Diabetes – HT Treatment
87.8 % 87 %
HRM < 5.0 % < 3 %
Baby Boomers are making their entrance 10,000 older adults turn 65 years of
age….EVERYDAY About 3% per year age-ins
A 65 year old patient is not a 75 year old Differences in
Technology Education levels
Increasing STAR ratings – who is the patient/beneficiary?
Opportunities?
Community pharmacy The front line to the patient and provider Trusted health care professional
Engaging the patient in their healthcare The missing link?
Partnering with providers Better educate and partner with providers on gaps in
care
Do STARS Make a Difference to the Patients?
JAMA Article
Analyzed patient behavior in 2011
952k first time enrollees and 323k “switchers”
Statistical significance found with star ratings and plan
chosen
STAR ratings were less likely to influence, youngest,
black, low income, rural and mid-west enrollees
Impact of CMS’ Outreach
Beginning last fall, notices were sent to enrollees in LPI contracts to consider better performing plans
From 2012 to 2013, more patients switched out of low performing contracts
Of those in LPI contracts that switched in 2013
Future of STARS?
More outcomes based measures to be added Quality will be at the forefront of the exchanges,
future of healthcare Weed out the low performing plans and ensure
health plans are offering high quality health care The “young” older adults will rely more on ratings to
choose health care which will increase the competitiveness
Summary
STAR ratings are pushing health plans to drive for higher quality and older adults are noticing the changes
Quality measurement has been a part of healthcare for many years but in recent years is tied to reimbursement
STARS will continue to evolve and more outcome measures expected to be added to the STARS overall rating
QUESTIONS
Complete evaluation at the end of the webinar Statement of credit available in CE/Test history folder Contact customer service with questions (800) 933-9666
CE Credit