CMS Quality Star Ratings Offer Opportunity for Adherence Evidence Generation

The Centers for Medicare & Medicaid Services’ (CMS) has implemented a five-star rating system for MedicareAdvantage and Part D health plans including measures of patient medication adherence for diabetes, hypertension and hypercholesterolemia. At the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Annual International Meeting, my colleagues and I discussed how these new adherence requirements create new opportunities for pharmaceutical companies to generate evidence to support improvement in these critical performance metrics for payers.

Through my panel titled, “Improving Medicare Star Ratings: Evidence in Support of the Use of Patient Medication Adherence Packaging as an Effective and Measurable Adherence Intervention,” we pointed to the fact that for health plans, achieving a five-star rating from Medicare has not only positive financial implications to payers due to its bonus structure, but 5-star plans are permitted to enroll beneficiaries year-round. Pharmaceutical companies can help health plans evaluate technologies to achieve higher adherence rates by offering  evidence of interventions that increase adherence and improve related clinical outcomes. Importantly, we focused on a roadmap for evidence generation to demonstrate improved adherence using the example of a unique adherence technology.

At Optum, we help clients develop evidence generation plans and strategies to support product value, including potential adherence benefits. The opportunity produced by the Quality Star Ratings program calls for multi-faceted, multi-dimensional approaches to adherence improvement, and distilling the impact of these approaches to support wise investment by payers, manufacturers, patients and others.

If you have any thoughts on this panel, I welcome your conversation at Carolyn.Harley@optum.com or post a comment below.   A full schedule of Optum’s contributions at ISPOR can be found at Optum.com.

–Carolyn Harley, PhD, MPA, Director, Market Access, Value Strategy and Health Policy, Optum

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