Be a top-performing pharmacy on Star Ratings measures: address adherence during med sync appointments

Address adherence

This is part of an ongoing series on how community pharmacies are demonstrating outstanding performance under measures CMS uses to calculate health plans’ Star Ratings. Although pharmacies are not assigned Star Ratings, a pharmacy’s actions can impact a health plan’s ratings. Those ratings affect plans’ reimbursement and enrollment period.

Medication synchronization frees up time and provides opportunity for patient-centered care

In brief:

  • Focusing on Star Ratings leads to measurable results
  • Educating staff about Star Ratings engages them in making improvements
  • Med sync allows pharmacists to uncover causes of non-adherence and address them
  • Increased communication with patients and physicians leads to better outcomes

As Sandie Kueker prepared during 2015 to become the new owner of Hesston Health Mart Pharmacy in Hesston, Kansas, she already was working to improve the pharmacy’s efficiency and performance.

By year’s end, Hesston Pharmacy was exceeding the five-star performance measure for medication adherence for cholesterol and hypertension medications, as well as limiting the use of high-risk medications in the elderly. Her pharmacy was among the top 20% of pharmacies for cholesterol adherence in the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP™) dashboard.

In addition, the pharmacy had enrolled more than 100 patients in its new med sync program, which is the number where pharmacies often begin to realize the benefits of improved efficiency. Kueker was also seeing results in her direct work with patients, identifying medication adherence issues and making their lives easier.

Hesston Health Mart Pharmacy: results in brief

Hesston Pharmacy fills about 1,200 prescriptions a week for the community of about 3,700, located about 30 minutes north of Wichita, Kansas. Its 2015 results include:

  • 5-Star Ratings on three performance measures
  • Top 20% performance on cholesterol PDC
  • 100 patients enrolled in med sync within three months

Educating staff about Star Ratings

“I was really focused on our Star Ratings,” Kueker said. Although the previous pharmacist was aware of the quality measures, he hadn’t engaged the staff on them. “It’s really important to tell your staff why it’s important,” Kueker said, so she took time during a staff meeting to explain what Star Ratings are and why they matter.

She explained Medicare’s desire to improve quality and reduce costs by grading insurance companies based on Star Ratings. She also described the impact pharmacies can have on those measures, and how following the guidelines for the quality measures leads to a pharmacy taking great care of its patients.

Kueker worked with the pharmacy staff to focus on key areas one at a time. She explained Star Ratings in the first quarter of 2015, focused on completing patient comprehensive medication reviews (CMRs) over the summer, and then led implementation of a medication synchronization (med sync) program. (CMS added CMR completion rates to its Star Ratings in 2016. See “What You Need to Know Now about CMRs.”)

Kueker keeps staff apprised of Hesston Pharmacy’s EQuIPP scores by printing them in color and posting them in the pharmacy. Green shows measures where the pharmacy has reached its goal and red shows where performance lags. Staff members pay attention to those results.

Spreading the word about med sync

Kueker launched Hesston Pharmacy’s med sync program after attending the 2015 McKesson ideaShare trade show and conference in June, which featured a med sync workshop. By August the program was up and running, and by November Hesston’s team had enrolled its first 100 patients.

When Hesston Pharmacy started med sync, Kueker went to the online Health Mart® Marketing Hub for marketing tools. “I love the resources on the Marketing Hub,” Kueker said. “It’s all really easy.” The pharmacy flagged patients it wanted to target for med sync and provided flyers as bag stuffers when these patients picked up prescriptions. Kueker said the flyers were effective at encouraging customers to ask about and sign up for med sync.

Addressing adherence issues

Hesston Pharmacy uses an appointment-based model. A team member calls patients each month before filling their prescriptions, talks with them, and pays attention to any issues. The call before filling prescriptions allows the pharmacy to deal with any issues it discovers, such as:

  • Side effects. Among the customers Kueker first targeted for med sync were several on metformin. When med sync revealed they were not taking the medication as prescribed, she was able to discuss the reasons and work with them to find solutions.For example, if the medication was causing stomach upset, she might contact the patient’s physician about changing to an extended-release formula, recommend taking the medication with food, or explain that often stomach problems subside after taking the medication regularly but recur if patients stop and start it again.
  • Compliance barriers. One patient was having adherence issues even though the patient’s son helped fill a weekly pillbox. Kueker talked with both of them about compliance packaging, which Hesston Pharmacy offers for a charge of $12 a month. That solution improved adherence and made life easier for the customer and caregiver.
  • Medication gaps. When reviewing medications for med sync, the pharmacy staff may notice a patient is taking metformin but not taking a statin. (Statin use in diabetes may become a Star Ratings display measure in 2017 and a full measure by 2018. See “CMS Releases Advance Notice of Changes for Calendar Year 2016.”) Hesston Pharmacy also sends physicians a list of their patients’ medications and checks it against the physician’s medication list for that patient. “We find a lot of gaps,” Kueker said.

Addressing medication issues with physicians is easier when the med sync appointment prompts the conversation. “We’ve really gotten a lot of patients straightened out,” she said. In addition, a Wichita physicians group working on a collaborative practice model contacted Kueker about participating because they heard of Hesston Pharmacy’s work with physicians. “Med sync opened the door,” she said.

Identifying patients for med sync

Kueker identified patients for med sync from CMRs she conducted and adherence outliers identified through EQuIPP and iMedicare. Next year, CMRs will be faster because of the information already available from the sync program. “It builds on itself year after year,” Kueker said.

Get additional resources and learn from your peers:

Visit the Driving Pharmacy Performance Education Center, sponsored by Health Mart, to learn more about quality measures and how to improve your pharmacy’s results.

Visit the Medication Synchronization Education Center, sponsored by Health Mart, to learn how to get started, get more patients and get more with med sync.