Star Boost Adherence for Medicare plans

Changing behavior across a population can be challenging. For high value, triple-weighted Star measures, you need a great partner with all the right tools, such as a nationwide network of MTM providers, predictive analytics and 21 years of MTM expertise.

Guaranteed performance

What if you could tell your leadership that you’ll get the adherence Star Rating they want? Let OutcomesMTM engage our multi-channel approach—including the largest, most active pharmacy network—to move the needle on adherence. With our patient-specific modeling, we deploy targeted interventions at the right time to help the member stay on track. We engage pharmacists across multiple delivery channels for a tailored interaction to help a member overcome the unique mix of adherence barriers they face. Select a performance guarantee that aligns with your goals for adherence-focused Star measures for diabetes, hypertension (RAS antagonists) and cholesterol (statins).

Star Rating

Choose your desired Star Rating for each adherence measure.

Adherent Rate

Select a target rate of members who reach ≥80% proportion of days covered (PDC).

Intervention Completion

Set your desired number of completed adherence interventions.

Improved adherence

Pharmacist intervention, prompted by TIPs in our widely used Connect Platform, spurs improvement or lays a foundation of support for maintained adherence. Here are two examples of members who achieved adherence after intervention by an MTM provider with OutcomesMTM. The charts show proportion of days covered (PDC) rates three months prior to the MTM intervention and three months after the intervention.

Pharmacist counseling patient on adherence

Multiple touchpoints keep adherence on track

Personal Pharmacist™ Hai Wu

A TIP indicated one of Hai’s patient was not adherent to their anti-diabetic medication. Hai reached out to the patient and counseled them on the value of adherence, converted them to a 90-day fill of their medication and enrolled them in the Adherence Monitoring Program. Hai monitored the patient through quarterly checkpoints to ensure the patient’s continued adherence.

Confirmed refill ensures medication supply

Personal Pharmacist™ Kendrick Pires

A TIP alerted Kendrick to a patient who needed a refill of their cholesterol lowering medication. Adherence to this medication is essential for controlling the patient’s cholesterol and helping to prevent a possible heart attack or stroke. With this in mind, Kendrick reached out to the patient to confirm a refill was needed. Kendrick filled for the requested 90-day supply and set the patient up to receive the refill through the pharmacy’s delivery program. He also noted the date for the next refill for the patient so they could remain adherent to the medication.

Targeted interventions

Our Insight™ Clinical Engine identifies the services most relevant to your members from a range of interventions designed to help them better understand their medication therapy, take it appropriately and stay on track for optimal results. Adherence services vary in intensity and may be targeted to members who are non-adherent or at risk of becoming non-adherent. The following services are examples of interventions that may be leveraged for members enrolled in your Star Boost Adherence program.

Adherence Monitoring Program

The pharmacist monitors adherence and connects with the member at checkpoints throughout the year to meet or exceed the adherence target

Adherence – Needs Check-in

The pharmacist counsels the member on importance of adherence, identifies potential and/or existing barriers to adherence and works with the member to overcome any barriers

Needs 90-day Fill

The pharmacist assists the patient in transitioning from a 30-day supply to a 90-day supply, reinforces the importance of taking the medication as prescribed and may address barriers to adherence

Needs Refill

The pharmacy proactively addresses refills to ensure the member has enough medication on hand

Medication Synchronization (MedSync)

To simplify the refill process, the pharmacist works to align a member’s chronic medications to a common fill date. Synchronizing fills can make it easier for the member to keep medications on hand and encourages a regular monthly conversation with the pharmacist to improve adherence and address any medication concerns.

New Therapy Consultation

The pharmacist follows up with a member after they start a newly prescribed medication to discuss the benefits and appropriate use of the medication and identify potential barriers to adherence.

Needs Disease State Education

The pharmacist educates on important disease state topics, such as a symptoms, associated risks, appropriate medication use, recommended monitoring and lifestyle modifications, to empower the member to better manage their chronic condition.

Have an RFP?

Our team actively responds to all requests for proposals. Submit your proposal online or contact us to share your RFP. We look forward to showing you how our solutions can help you reach your goals.