RxAnte clients experience year-over-year (YOY) improvements in adherence rates and CMS 3x weighted adherence measures, despite persistently rising cut points. CMS’s release of the 2019 Star Ratings cut points on September 11 confirmed, yet again, that RxAnte Medicare Advantage Part D (MAPD) clients show increasing, consistent improvements. Though industry-level performance will be available next month, RxAnte clients are performing well according to the recently released cut points. Specifically:

  • An estimated 75% of client contracts will attain the same or better Star Ratings when compared to last year.
  • Average improvement of RxAnte-managed contract measures increased from 1.5% to 2%.

For 2018, 96 percent of RxAnte-managed contracts are on track to improve adherence.

Addressing the Challenge of Rising Cut Points

Many health plans are understandably concerned by the significant rise in the RASA and statins measures for 2019 Star Ratings relative to their own performance. Poor adherence risks losing plan membership and missing performance bonuses and can signal weaknesses in several areas of plans’ adherence programs. For example, poor or undesired performance can mean:

  • A plan’s strategy may not be where it should be. For example, program managers may be using trailing PDC versus prospective targeting, which keeps them looking backwards to gauge performance and leaves little room to accurately refine strategy.
  • Resource allocation could use enhancements. Manual workflows, emails, multiple spreadsheets – these seemingly innocuous tasks keep valuable employees from making real impacts and engaging with members.
  • Populations insights may need optimizing. Again, a retrospective view prevents plans from being able to predict and anticipate challenges. Furthermore, poor targeting may leave plans intervening with members who will not benefit from it, resulting in unchanged adherence rates.

Plans Can Still Improve Performance

With cut points increasing each year, the struggle to reach desired quality ratings will only continue. Despite what your plan’s performance was in 2017, it’s still not too late to improve your adherence rates for this year. RxAnte helps plans monitor and improve their strategy, increase efficiency, and ultimately increase their Star Ratings and population-level adherence. Our Star Ratings solution is purpose-built to help your plan achieve your Star Ratings goals and more. We use predictive analytics and integrated solutions that create workflow efficiencies and bring much-needed member and plan-level insights into adherence performance. We also help you take advantage of opportunities to view pharmacy- and provider- level data and drive adherence through these vital touch-points. Ultimately, we accurately forecast possibilities to implement targeted interventions, eradicating small problems before they become insurmountable challenges.

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.