Improving Star Ratings through Pharmacist Intervention

Presented by The Mirixa Corporation 

As part of the Affordable Care Act, a three-year demonstration project was kicked off early in 2012 to provide financial incentives in the form of quality bonus payments to Medicare Advantage Plans that achieve an overall CMS Star Rating of 3 or higher (1= low, 5=high). The webinar will detail how pharmacist-delivered patient care services can help influence a plan’s overall rating. Health plan attendees will learn how patient engagement by pharmacists can impact the quality of patient health outcomes, patient safety, and overall health plan ratings.

Medicare Advantage Plans with prescription benefits receive Star Ratings based on 53 measures; 36 of which are in Part C space.  The measures are grouped into the following five domains:

• Staying Healthy
• Managing Chronic Conditions
• Plan Responsiveness and Care
• Members’ Complaints, Problems Getting Services and Choosing to Leave the Plan
• Health Plan Customer Service

Many of the clinical measures which fall under the domains of Staying Healthy and Managing Chronic Conditions can be effectively addressed and improved by pharmacists through the provision of MTM and Targeted Quality Interventions.

Seventeen additional measures are in the Part D space and are grouped into these four domains:

• Drug Plan Customer Service
• Member Complaints, Problems Getting Care and Choosing to Leave the Plan
• Member Experience with Drug Plan
• Drug Pricing and Patient Safety

Five of the seventeen Part D measures are ones pharmacy can directly influence with patient care services such as MTM and Targeted Quality Interventions.  Additionally, these same five measures are triple weighted and thereby are of great importance to health plans.

The webinar will discuss many of the Part C and the five Part D measures pharmacists can influence. Market information will also be provided which demonstrates why the pharmacist is best positioned to deliver these services.

List of Speakers: 

Kim Swiger, RPh, Vice President of Clinical Marketing, The Mirixa Corporation

Kim Swiger is a registered pharmacist and is responsible for strategically guiding Mirixa’s product and service offerings, and clinical program design to correspond with market and industry trends. Kim brings more than 20 years of community pharmacy practice to her role. Prior to joining Mirixa, Kim spent the majority of her career at Ukrop's Pharmacy where she was involved in innovative patient care programs, continuous quality improvement and pharmacy operations, including two APhA Foundation Projects. Kim is a committee chairperson with PQA, and is a member of APhA, Virginia Pharmacists Association, Georgia Pharmacists Association and the Academy of Managed Care Pharmacists. Kim earned her BS in Pharmacy from Virginia Commonwealth University School of Pharmacy. 

 

The content presented in this webinar is solely attributable to the speaker and does not represent an endorsement by America's Health Insurance Plans (AHIP) of the accuracy of the information presented in the audio conference or any opinion expressed by the speaker.