Community pharmacy and CMS Star ratings

The Star ratings program instituted by the Centers for Medicare and Medicaid Services (CMS) has made community pharmacy’s role in improving medication safety and adherence more critical than ever before. Because of Star measures, pharmacists have the opportunity to strengthen their services, using their robust patient relationships and technology to improve patient outcomes.

Star measures 101

Medication nonadherence costs the healthcare system more than $300 billion annually, and this number has caught the attention of policymakers and CMS.

To address these costs, CMS grades Medicare prescription drug plans (MA-PDs and PDPs), using its Five-Star Quality Rating System to measure performance and track patient outcomes.The five medication-use measures that are weighted the heaviest focus on medication safety and adherence in: members age 65 and older on medications with high risk of side effects; members with diabetes using recommended blood pressure medications; patients taking oral diabetes medication as directed; patients taking blood pressure medication as directed; and patients taking cholesterol medication as directed.

Pharmacists can play a critical role through their ability to influence the medication-use measures. Every day, pharmacists work to overcome adherence barriers and develop practical regimens to enhance overall patient outcomes through safer and more effective treatments. Drug plans rely on pharmacists, with their established relationships with patients, to boost medication safety and adherence results, which account for nearly half of some drug plans’ overall scores.

An ongoing challenge for pharmacists is balancing pharmacy operations and patient interactions. Creative use of available technology can provide methods that increase the focus on safety and adherence while improving efficiency within the pharmacy. Not only can technology help pharmacists achieve Star-related goals; the time saved can be spent counseling patients, working on medication therapy management (MTM) cases, and improving patient outcomes.

Technology and quality of care

Pharmacies can use existing pharmacy management systems and industry solutions to support medication adherence by offering such value-added services as: automated refill notifications, including text, e-mail, and voice messaging; prescription pick-up notifications; online refill requests and mobile technology; and ongoing measures of patient progress in the therapeutic classes monitored by the Star system.

Pharmacists can consider investing in web-based systems that provide visibility on their CMS Star measure performance. At Good Neighbor Pharmacy, we provide independent pharmacies with access to Pharmacy Quality Solutions’ EQuIPP (Electronic Quality Improvement Platform for Plans and Pharmacies). The system reports pharmacy scores on each of the five CMS Star measures of medication use, allowing pharmacists to track how they are being measured by each health plan.

High-touch MTM can also enhance patient care and outcomes, and the end goals of MTM practice align with the five Star measures on which pharmacists focus. As pharmacies continue to work with their MTM patients, online tools available from Mirixa or OutcomesMTM can help them manage these cases more efficiently.

Beyond the traditional forms of technology, pharmacists can take advantage of the free medication synchronization program from the National Community Pharmacists Association, and they can consider employing adherence consulting services, such as MedHere Today, that can advise them on use of technology to further improve adherence.

Technology and operational efficiencies

Skyrocketing demand for prescriptions coupled with personnel shortages creates overwhelming workloads for pharmacies. Technology for operational efficiency helps streamline behind-the-counter processes so that pharmacists can focus on achieving improved patient outcomes.

Pharmacy automation can help pharmacies manage high prescription volume and overcome challenges to delivery of safe, efficient patient care, as well as boost pharmacy productivity and materials management.

Inventory tracking, product procurement, and vendor management take considerable personnel time. Systems for inventory management and dispensary workflow can remedy these problems.

The impact of CMS’ Star measures has yet to be fully realized, but we do know that independent community pharmacists have the expertise and accessibility to provide care that creates positive changes in a patient’s adherence and outcomes.

If performed effectively, the implementation of new technology can mean more repeat customers and increased growth and profitability. More important, these approaches can maximize the level of care to patients and produce better outcomes.

Scott Robinson is vice president, Good Neighbor Pharmacy, for AmerisourceBergen Drug Corp.