Whether it’s cut point season or not, Star Ratings sit at the top of the list of priorities for Medicare Advantage and Part D plans everywhere. In many cases, these plans rely on retrospective analysis of claims data to inform future programs and interventions. Although there is some value in using trends from previous years to inform strategy, it misses the mark when it comes to improving medication adherence rates. To help plans get what they need from data that both informs planning and drives improvement, we take a closer look at comparing retrospective vs. prospective strategies.
The Issues with Looking Back to Get Ahead
Looking at historical data and generating reports on program performance a couple of times a year is a great way to determine refinements for the coming year. You can use this to customize your approach, increasing your ability to meet your business goals, and can weed out parts of the process that may not work for you.
However, this is problematic in that it doesn’t allow you to look forward. It doesn’t take necessary factors into account, such as fluctuating quality measures, and will not be likely to help you reliably improve medication adherence rates or maximize your Star Ratings. Instead, you need to use data to project, or forecast, future performance as well. This gives you both strategy refinement tactics and the ability to accurately track toward year-end performance.
All Predictions Are Not Created Equal
It’s important plans understand what accurate, reliable forecasting entails. Forecasts that lead to Star Rating and quality improvements must include adherence over 12 months, incorporate both single- and double-fillers, and rely on near real-time claims data. Anything less is only guesswork and loses the precision and trustworthiness you need to succeed.
For MAPD plans seeking to optimize adherence rates, it’s important to note that vendors that conduct retroactive analyses of prescription drug events (PDE) are more than likely overestimating adherence rates at the beginning of the year. This gives plans an unrealistic baseline on which they are formulating and developing the remaining year’s adherence strategy. In reality, PDE analyses tend to gradually decrease over time as members miss scheduled fill dates, thereby producing an unnecessary obstacle to efficient and effective population-level adherence strategies.
By both accounting for those members who are adherent, as well as those who are likely to become adherent through targeted intervention strategies, forecasting provides a much more realistic projection of a plan’s adherence performance over time.
Data Is Not an “Either/Or” Situation
Plans don’t need to choose between prediction or analysis when it comes to achieving your Star Ratings goals. In reality, both are required to create a complete picture of where you’ve been and where you are going, so you can get to where you want to be. This should be combined with workflow solutions, targeting measures (that show who to target and who is most likely to improve), and member and plan-level insights. This comprehensive and integrated solution helps plans prepare, grow, and, ultimately, improve.
Contact us here for a no-obligation assessment to finish this Star Ratings year on a high note and start strong in the coming year.