Best Practices for Leveraging In-Home Assessments to Improve Part D Star Ratings

Dec 19, 2016 1:02:00 PM

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Since only 49 percent of Medicare Advantage Part D active and rated plans in 2017 received 4 Stars or better for their 2017 overall rating, many are seeking ways to improve Part C and Part D measures that impact these scores.
  

2017 Rating (MA-PD Contracts)

%  Contracts

4+

49%

3.5

29%

3

18%

2.5

3%

Avg.

4.0

 

While Part D consists of 15 measures compared to 32 Part C measures, several are heavily rated and play a critical role in determining your Star Rating. Here are three ways in home health assessments can help you improve Part D ratings for your health plan.
 
1. MTM Program Completion Rate for CMR - D15
This measure was new in 2016 and had an average rating of 2.8 in 2017—a challenging measure to say the least. In-home assessments can bridge the gap where internal programs are unsuccessful. A medication reconciliation, which is already conducted each time a member is evaluated, can increase Comprehensive Medication Review (CMR) completion rates and scores. Coordination of efforts between the Risk Adjustment and Pharmacy departments can optimize the CMR completion rate by conducting in-home assessments for MTM eligible members. This avoids duplication of outreach efforts by leveraging the medication reconciliation information already collected during the in-home visit. CenseoHealth generates Personal Medication Lists and Medication Action Plans to reinforce patient understanding, ensure coordination and comply with CMR requirements. It also reduces the need for a telephonic outreach program and decreases member abrasion. In fact, one CenseoHealth plan who leveraged in-home assessments for the CMR component of their MTM program saw a 23 percent decrease in average inpatient days over a six month period.  

2.  High Risk Medication – D11
Now that CMS has charged health plans with reducing incidents where seniors are repeatedly prescribed high-risk medications, plans need a process to identify potential issues and educate members on the risks of these drugs. Especially tricky are benzodiazepines which remain the most commonly prescribed agents for sleep problems such as insomnia, a frequent complaint amongst the elderly. High Risk Medication use can be identified during an in-home health assessment by reviewing the member’s adherence and dosage to determine if there is an increased risk that needs to be addressed.

3. Medication Adherence – D12, D13, D14
Just like high risk medication reviews, you can also influence three additional measures with the information you collect through your in-home health assessment program. In addition to gathering critical information, the face to face interaction allows physicians to educate members on the benefits of the prescribed medications and identify any access issues that may be impacting their adherence.  This includes diabetes, hypertension and cholesterol medications.

Want to learn how a CenseoHealth assessment program can impact nine Part C Star Ratings measures plus five Part D measures?
Download our Leveraging Health Assessments to Improve Your Star Rating eBrief:

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