New Adhere Platform™ capabilities support dramatic CMS Increase of Medicare Advantage CAHPS Member Experience Star Rating Weighting to 32% through technology-enabled telepharmacy outreach
NASHVILLE, Tenn., May 6, 2021 – AdhereHealth, a healthcare technology leader in medication adherence insights and health outcomes, today announced the release of new member experience capabilities to improve Medicare Advantage (MA) Star Ratings health plan satisfaction through its next-generation Resolve™ offering. The new capabilities prioritize members at highest risk of poor member experience that is reflected in Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Health Outcomes Survey (HOS) assessments.
For over a decade, AdhereHealth has been committed to improving Star Ratings performance through medication adherence and quality issues by overcoming member experience issues such as social determinants of health (SDOH), provider access and satisfaction with their health plan or doctor. With the quadruple weighted CAHPS measures that CMS implemented in 2021, Resolve’s robust new capabilities expand the solution focus to include all MA membership likely to have a poor experience, as reflected in health plan CAHPS and HOS scores. Through the foundational customer relationship management (CRM) toolset and rich data visualizations, Resolve addresses CAHPS and HOS issues, illustrating year-round population-level and unique member status for each respective survey measure at risk.
“We believe missing information and misinformation are at the core of member experience issues. These problems can be squarely addressed by the right combination of technology and telepharmacy outreach,” said Jason Z. Rose, CEO of AdhereHealth. “Our Resolve solution uses proprietary analytics, clinical workflow, available health plan benefits and local community social service software integration to overcome CAHPS-related member experience issues that impact Star Ratings due to poor satisfaction.”
The new capabilities come at a critical time. CAHPS scores now represent 32% of the overall Star Rating score. MA plan CAHPS questions related to getting needed care, quality of communication from providers, and understanding prescription medication guidance will be among the most significant contributors to quality performance. Each year, CMS allocates nearly $7 billion dollars of increased value-based reimbursement to MA plans based on the highly competitive Star Rating performance.
Ongoing pandemic issues place even higher focus on connecting members with their health plan benefits, access to care, financial issues, isolation issues and general well-being. For example, MA plan members remain reticent to visit their doctor and data represents high levels of COVID-19 vaccination hesitancy.
Anchored within the Adhere Platform, the Resolve offering analyzes near real-time data from dozens of sources to dynamically identify which consumers are not engaged with their health plans and non-adherent to their medications. The new member experience capabilities guide telepharmacy clinicians in their member outreach to address gaps in care, support medication adherence, alleviate SDOH barriers to care, and immediately facilitate available benefits and community social service resources.
“AdhereHealth strives to focus on non-engaged and non-adherent members by addressing real-world problems facing the consumer. It’s the Maslow Hierarchy of Needs for healthcare – food insecurity, safe living environment, transportation, and access to care. Our telepharmacy team combines the mind of a clinician with the heart of a social worker to systematically improve health and satisfaction of our patients through meaningful touchpoints. As CMS continues to increase a Darwinian focus into healthcare, Medicare Advantage plans that aggressively improve member experience gain higher value-based reimbursement that creates more competitive benefits to their membership,” said Rose.
To learn more visit adherehealth.com/solutions/resolve-health-plans/
AdhereHealth delivers purpose-built, innovative technology solutions to improve quality of care, medication adherence and cost outcomes – all with an emphasis on overcoming social determinants of health (SDOH) and improving patient experience. AdhereRx, an AdhereHealth company, provides high-risk, underserved patients with personalized pharmacy services that drive medication compliance and reduce unnecessary utilization costs. This unique combination of predictive analytics, intelligent clinical workflow software and proactive telepharmacy outreach performed by a nationwide team of licensed clinicians addresses an estimated half a trillion dollars of unnecessary annual medical costs attributed to medication adherence issues. Today, the Adhere Platform™ touches nearly 30 million patients across dozens of health plans, self-insured employers and other risk-bearing entities. Learn more at www.adherehealth.com.