Be a Top-Performing Pharmacy on Star Ratings Measures: Med Sync Improves Adherence and Operations

January 18, 2015 by Smart Retailing Rx
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This is part of an ongoing series on how community pharmacies are demonstrating outstanding performance under measures that CMS uses to calculate health plans’ Star Ratings. Although pharmacies are not assigned Star Ratings, a pharmacy’s actions can have a dramatic impact on health plans’ ratings. Those ratings affect plans’ reimbursement and open enrollment periods.

Synchronized refills benefit patients, prescribers and the pharmacy

When the owner of 5 Minute Pharmacy in Hawaii first saw his pharmacy’s scores on various Star Ratings measures, the numbers were daunting. “They were all red at first,” Derek Tengan explained, which showed that his pharmacies were not meeting or exceeding the five-star goals.

“It takes time to start making traction on the scores,” Tengan said, but the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP™) dashboard has helped him track progress. For the period from April through September 2014, both his pharmacy in Honolulu and the location in Waipahu exceeded the 2015 goal levels in two measures:

  1. Adherence to drug therapy for treatment of diabetes
  2. Minimizing the use of high-risk medications in the elderly

To improve performance on Star Ratings measures, “It’s not about finding a perfect system, but taking one step at a time,” Tengan said. One important step for 5 Minute Pharmacy is offering medication synchronization, which it started in September.

In just four months the pharmacy signed up nearly 400 patients for med sync, and Tengan expects to add 50 to 100 new patients per month to the program. In addition to using its pharmacy software to identify customers who use multiple medications (and therefore need multiple refills), the pharmacy also offers to synchronize the medication refills of every new customer.

Med Sync Benefits the Customer, Provider and Pharmacy

“Before Star Ratings came along, I never thought there was a reason to [offer med sync],” Tengan said. Now he wishes he had started the program earlier. “It improved all aspects of the business,” Tengan said.

By aligning refill dates for customer prescriptions, the pharmacy is able to better manage its inventory and make fewer deliveries. “Our volume has increased, and we haven’t had to hire additional staff,” Tengan said. When one of its six drivers left, the pharmacy didn’t need to replace the person, because synchronized orders require fewer deliveries. Before offering med synchronization, he said, “Our phone rang off the hook.” A driver might have made a free delivery of medication to the same home six times in a month.

“Doctors love it too,” Tengan said. “They get fewer phone calls.”

In addition to medication synchronization, the pharmacy also offers free compliance packaging and free delivery.

The Payoff from MTM

The pharmacist in charge of the med sync program also conducts medication therapy management (MTM). Med sync provides a holistic monthly view, which allows the pharmacist to continuously review and monitor each patient’s medication regimen. Med sync also helps facilitate the delivery of MTM because the pharmacist knows when the patient is coming in and can schedule services accordingly. The pharmacy provides the service whether it can receive reimbursement for that patient or not. A pharmacy owner shouldn’t necessarily look at MTM as a way to grow revenue directly, Tengan said. “You do it because it’s the right thing to do. It helps the patient, and it helps our scores.”

While med sync can improve the three quality measures related to adherence, which is measured by refills, MTM allows the pharmacist to address the other two quality measures: whether diabetic patients with hypertension are on a renin angiotensin system antagonist, and reducing the use of high-risk medications in the elderly.

Payers are also beginning to see the benefits of pharmacy intervention and services. By helping better manage just 10 high-risk patients, 5 Minute Pharmacy saved a local health plan an estimated $180,000 over six months by reducing ER visits, hospital admissions and readmissions, Tengan said.

Show Staff Why Star Ratings Matter

Although 5 Minute Pharmacy has staff members dedicated to its med sync and MTM efforts, it’s important for all staff members to be involved and communicating about how they can better serve patients with those programs, Tengan said. “It needs to be an evolving program.” He discusses those programs as part of his monthly staff meetings.

Tengan also took his core staff members to a pharmacy town hall meeting on quality measures hosted by Health Mart®. It’s important for the staff to understand why the quality measures matter, and not just that the pharmacy owner cares about the numbers, he said. “Our successes are as a team. They do all the work.”

3 steps to improve performance with med sync

The three Star Ratings measures for adherence measure whether patients have filled prescriptions enough to cover at least 80% of the time they are supposed to take those medications. That’s why programs that make it easier for patients to stay on track, such as medication synchronization and compliance packaging, can have a big impact on those measures. Here are three keys to launching a successful med sync program:

  1. Explain the benefits to patients. Identify patients who are taking multiple prescriptions, and explain your program to align the refill dates. Once you explain it, “Nobody says ‘No,’” said Derek Tengan, owner of 5 Minute Pharmacy in Hawaii.
  2. Dedicate staff to med sync. Tengan added a pharmacist and 2.5 technicians to handle only medication synchronization and MTM. If you make synchronization an add-on assignment to existing staff, Tengan advised, they will be distracted by their regular responsibilities. He hired a pharmacist who is specifically trained in performing MTM and working with physicians.
  3. Educate the physicians. Tengan met with local doctors to explain the process his pharmacy would be following and how it would benefit the providers as well, through fewer phone calls from the pharmacy and better Star Ratings. Now one of his pharmacists has lunch about three times a month with doctors to talk about the program.

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This series profiles what some pharmacies have done and does not provide legal or other professional advice. Readers should research legal requirements and tailor any programs to their practices, after consulting appropriate professionals for advice and assistance. For more articles, continuing education, and guides on Star Ratings and pharmacy performance, visit the Driving Pharmacy Performance Education Center sponsored by Health Mart.