Abstract
Appointment-based medication synchronization (ABMS) programs have been associated with increased adherence and persistence to chronic medications. Adherence to statin therapy, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non-insulin antidiabetic medications (NIDM) are used to determine a health plan’s Centers for Medicare and Medicaid Services (CMS) Star Rating under a pay-for-performance model. The objective of this study was to evaluate the impact of implementing an ABMS program on overall pharmacy adherence measures for statins, ACEI/ARBs, and NIDM, as presented through the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP©) platform. This retrospective, pre-post ABMS program study evaluated EQuIPP© generated adherence performance measures, represented as proportion of days covered (PDC), 6-months before and 6- and 12-months after the ABMS service for statin therapy, ACEIs/ARBs, and NIDM. All adherence measures showed statistically significant improvement in PDC percentage post ABMS implementation, except for NIDM percentage in 6-months post-ABMS service. This study shows that a comprehensive medication synchronization program can enhance adherence measures that are important to health plans to increase CMS Star Rating under a pay-for-performance model.
Highlights
As the United States health system moves toward a pay-for-performance model, reimbursement for health care-related services are based on predefined outcomes that aim to reflect the quality of care provided
This study shows that a comprehensive medication synchronization program can enhance adherence measures that are important to health plans to increase Centers for Medicare and Medicaid Services (CMS) Star
Star Rating criteria are directly related to medication adherence, such as adherence to statin therapy, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non-insulin antidiabetic medications (NIDM) [1]
Summary
As the United States health system moves toward a pay-for-performance model, reimbursement for health care-related services are based on predefined outcomes that aim to reflect the quality of care provided. A pay-for-performance model incentivizes providers to improve health outcomes for patients while maximizing cost-savings. Under a pay-for-performance model, health plans are rated based on Centers for Medicare and Medicaid Services (CMS) Star Rating criteria. Star Rating criteria are directly related to medication adherence, such as adherence to statin therapy, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non-insulin antidiabetic medications (NIDM) [1]. Medication nonadherence in chronic disease such as diabetes and hypertension contribute to increased morbidity, mortality, and unnecessary health care costs [2,3,4]. There are multiple factors affecting medication nonadherence such as socioeconomic, patient-related, condition-related, therapy-related, and health system-related factors. An appointment-based medication synchronization (ABMS) program allows a pharmacist a scheduled opportunity to build relationships with their patients
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