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