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Four Ways to Drive Engagement and Medication Adherence in Rural Medicare Populations
With the release of the 2025 Star Ratings, the landscape for Medicare plans has shifted dramatically. This year’s ratings reflect
Behavioral Science–Driven Solutions for Improved Adherence
Innovative technology and SDOH-first strategies to enhance value-based performance and reduce medical loss ratios (MLR)
AdhereHealth™ delivers purpose-built, solutions that align behavioral science, advanced technology and expert clinical outreach to optimize value-based performance and MLR.
We partner with managed care organizations, self-insured employers and other risk-bearing entities to engage members across the risk spectrum—including the highest-risk, hardest-to-reach populations. By addressing social determinants of health (SDOH) and behavioral barriers and leveraging our proprietary predictive analytics and intelligent workflow software, we deliver personalized interventions that enhance medication adherence and improve health equity.
Through evidence-based telepharmacy outreach techniques from our nationwide team of licensed clinicians, AdhereHealth drives measurable improvement in government-sponsored pay-for-performance programs and value-based cost reduction initiatives.
Value-Based
Care Reimbursement
Increase Star Ratings and excel in P4P programs in your highest-risk members by addressing SDOH and medication adherence with targeted solutions rooted in behavioral science.
Adhere Platform™
Leverage AdhereHealth's healthcare technology, available on its own as SaaS and underlying all our proprietary solutions, to drive maximized value-based reimbursement and cost reduction.
Value-Based
Cost Reduction
Maximize reduction of drug therapy problems (DTPs) and improve medical cost savings through predictive analytics with aligned medical and prescription claims review, plus other opportunities for additional savings
What Our Customers Are Saying
In Their Words
"To put AdhereHealth’s impact in perspective, our plan’s CMS Star Rating was 2.5 prior to using Adhere, which was very low.
We engaged Adhere to work with our medication adherence measures and we improved 1 to 1.5 points for each measure in the first year of the program.”
VP of Stars
Regional Health Plan
"I think they're really strong in analytics for at-risk population identification. And, they're able to onboard additional members and programs quickly.
Their scalability is a huge value because inevitably in Q4, we always need something else, and they're always able to accommodate that, which has been key to our multi-year relationship with them."
Senior Director Technology Solutions
Regional Health Plan
"Part of our decision-making is the member experience the vendor is able to provide.
We're a very high-touch organization. So we want to make sure that members are seeing value in the experience. So that's one of the things that we look at, which comes along with the AdhereHealth solution."
AVP, Performance Programs & Reporting
Regional Health Plan
"Pricing is definitely one of the keys to our decision process. And specific to pricing, AdhereHealth's outcomes-based billing model, where they work our members and only get paid if they benefit our business, is a big factor for us."
Senior Director of Technology Strategy & Solutions
National Health Plan
"So we were looking for an end-to-end platform that could help us with adherence that was why we started talking to AdhereHealth and ultimately led to us going with them.
The Adhere Platform can connect and integrate with a range of pharmacy services including the PBMs. It parses out the patient information and provides the support, the risk levels and things that are needed to best manage a Medicare patient population."
VP Digital Experience, Regional, Resolve, MA
Regional Health Plan
"I know from an enterprise perspective, there are other markets that have a relationship with AdhereHealth too.
Our particular plan started using them across our entire population in 2018. Since then, we’re in our second 3-year contract with them.”
AVP, Performance Programs & Reporting
National Health Plan
"Another thing we like about AdhereHealth is how good their language capabilities are. This allows them to support our diverse patient population very well.
In different states, our members' primary language may be Spanish, Mandarin or several other Asian languages. Adhere is able to support all of these languages well, communicating with the member in their primary language.”
VP of Stars
Regional Health Plan
"We needed help as far as reaching more at-risk members. In addition to excelling at that, AdhereHealth offers additional benefits, like addressing mental health and many other HEDIS measures. They provided a higher touch approach that reaches more members and gets them adherent.
Based on some webinars that AdhereHealth put out at the end of last year, they're thinking in the right direction with whole patient care.”
Senior Director of Enterprise Pharmacy for Government Programs
National Health Plan
I need help with...
Medicare Part D / Adherence
Medicare Part C / HEDIS
MTM
Health Equity
Patient Experience
Medication Optimization
Medicare Part D / Adherence
AdhereHealth Solutions and Services
AdhereHealth programs drive Part D performance improvement* by targeting at-risk members and resolving SDOH challenges to achieve and maintain adherence.
Our solution provides:
- Part D performance improvement
- Our full-risk, outcomes-based performance guarantee
- Long-term SDOH barrier resolution for improved health equity
Our SDOH-first approach is powered by our proprietary Adhere Platform and utilizes sophisticated daily predictive analytics, which leverage a combination of plan-provided data and publicly available SDOH data, to identify members at risk of non-adherence. Our robust healthcare analytics (available as SaaS or in tandem with our nationwide clinician team) empower the efforts of outreach clinicians to help members tackle the barriers to adherence. This paves the way for long-term, longitudinal adherence and increased performance on Part D / pharmacy measures for government-sponsored lines of business (Medicare, Medicaid and Exchange plans).
We impact the following measures:
- Medication Adherence for Diabetes Medications (MAD)
- Medication Adherence for Hypertension (RAS)
- Medication Adherence for Cholesterol (Statins)
- MTM Program Completion Rate for CMR (MTM)
- Statin Use in Persons with Diabetes (SUPD)
- Getting Needed Prescription DrugsConcurrent Use of Opioids and Benzodiazepines (COB)
- Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)
- Polypharmacy: Use of Multiple CNS-Active Medications in Older Adults (Poly-CNS)
- Looking for a measure not in the list? Contact us to request additional measures.
*Addressing the needs of Medicare, Medicaid and QHP Exchange plans
Medicare Part C / HEDIS
MTM
Health Equity
Patient Experience
Medication Optimization
How We Make An Impact
Real Patient Stories
Roberta is 67 and her muscle pain was being treated with methocarbamol, which increases the risk of falling for consumers over 65 or older. AdhereHealth analytics identified tizanidine as a safer alternative, alerting our nurse to discuss the gap with Roberta’s clinician prompting a medication change.
David’s cholesterol medication refill was months overdue and during AdhereHealth’s CMR, he stated the discontinuation was due to receiving positive lab results. Our pharmacist convinced David the good lab results were a result of the medications, addressed the serious health risks with him and the consumer immediately refilled the medications.
Julie was taking a high-dosage of morphine for pain, but due to side-effects her physician changed medications to hydrocodone, oxycodone and acetaminophen. AdhereHealth analytics identified a acetaminophen dosage guideline issue, prompting our pharmacist to contact Julie’s physician to discuss alternatives and ultimately improved the chronic pain management.
Ida R. has type 2 diabetes and misunderstood how her insulin would regulate glucose release during the early dawn hours. AdhereHealth analytics identified insulin fill gaps that increased Ida's risk of complications and future hospitalizations. Upon our clinician intervening, Ida was educated about the importance of insulin and diabetes educational support. Ida returned to her prescribed care plan, improving her quality of care.
Greg’s hospital discharge plan included new medications to treat his cholesterol. AdhereHealth’s analytics identified a high statin dosage and upon a discussion with our pharmacist, it became clear Greg was taking two statins prescribed by two physicians. Greg met with his doctor to resolve the error.
Keith is in a long-term care center and was taking blood thinners warfarin and dabigatran as part of his daily regimen. AdhereHealth immediately contacted Keith's provider about the oversight. The provider agreed to discontinue one of the blood thinners. The Adhere Platform™ identified therapy duplication, preventing severe bleeding and other potentially life-threatening complications for this consumer.
Ed has type 2 diabetes and is at risk for heart disease and/or stroke. AdhereHealth’s analytics identified a gap in statin usage for his diabetes and this prompted our nurse to reach out to Ed’s doctor. The doctor prescribed lovastatin to Ed and it addressed the quality issue.
Carla struggled with high blood pressure and her losartan prescription was out of refills. AdhereHealth’s pharmacist reached out to Carla due to medication adherence analytics identifying medication gaps and subsequently contacted the physician for the refill order and improved quality of care.
Mrs. Robbins’s heart disease requires simvastatin and clopidogrel to reduce heart attack and stroke risk. AdhereHealth's medication adherence analytics prompted our pharmacist to discuss these risks. Mrs. Robbins supported the plan, improving quality and reducing her risk of hospitalization.
Margaret’s chronic asthma benefits from a rescue inhaler for flare-ups. AdhereHealth's analytics showed a prescription gap and during AdhereHealth’s CMR discussion, our pharmacist discussed the issue with Margaret, prompting outreach to her doctor for an order to prevent asthma emergencies.
Stephen was prescribed lisinopril for high blood pressure but missed doses increasing risk for cardiac arrest. AdhereHealth’s analytics identified the risk and upon our clinician’s discussion with Stephen about his apparent memory issues, a pill organizer was facilitated ultimately improving adherence.
Josh’s medication was changed from lisinopril to losartan for his hypertension. AdhereHealth analytics identified Josh hadn’t filled the lostaran which increased risk for stroke. Our clinician contacted Josh who was confused and followed up with his pharmacist and physician to close the gap.
Wanda is on 13 medications to support her multiple health conditions. The AdhereHealth medication optimization solution helped Wanda synchronize her medication refills and get home delivery of her medications to her home monthly. Our pharmacist also helped Ms. Jones order a blood pressure cuff to monitor her blood pressure.
Karen was taking two antidepressants and during a CMR, AdhereHealth’s analytics alerted our pharmacist to a potentially dangerous medication duplication. Our pharmacist discussed the issue with Karen and subsequently the consumer addressed the issue with her doctor. The doctor modified her regimen thus improving her overall care plan.
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