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For Medicare Advantage plans, medication safety is both a performance- and outcomes-influencing factor that’s become a permanent fixture within the CMS Star Ratings. And for many plans, the October 8th results revealed room for improvement.
The 2027 Star Ratings are the first year MA plans have been measured for performance on the medication safety measures Concurrent Use of Opioids and Benzodiazepines (COB), and Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH). And across the 508 contracts analyzed, 103 (20%) received 1–2 Stars on COB and 122 (24%) received 1–2 Stars on Poly-ACH.
Plans seeking to improve future performance and support safer medication use need a proactive strategy for identifying potential risks and coordinating clinical review.
Provider partnership is central to this work. Effective partnerships require health plans to understand the barriers providers face and offer useful information, practical support and a clear path toward clinical action to improve members’ safe medication use.
A provider-first approach helps MA plans address medication concerns while reducing member confusion and abrasion. Check out our webinar replay for actionable insights directly from clinicians!
Why is a provider-first approach important for medication safety?
A provider-first approach brings potential medication risks to the clinicians who can evaluate them within the member’s treatment plan.
Claims data can flag a potentially concerning medication combination, but it does not capture every circumstance affecting whether therapy is appropriate. A prescriber can offer that context, assess the clinical rationale, weigh benefits and risks, and determine whether a change is warranted.
This context matters when members have taken medications for years or receive prescriptions from multiple clinicians. Outreach that raises concerns without coordinating with the prescriber may create uncertainty for a member or undermine confidence in an established treatment plan.
Engaging the appropriate provider helps the health plan and care team align on next steps and communicate consistently with the member. It also keeps the conversation focused on clinical safety while supporting measure improvement.
What gets in the way of effective provider partnership?
Busy providers, many of whom are currently facing shortages within their practices, are constantly forced to do more with less. To that end, provider partnerships become harder when outreach adds work, leaves questions unanswered or overlooks the realities of clinical care.
Several barriers can prevent a medication safety concern from receiving the attention it needs:
- Alert fatigue. Providers receive a high volume of notifications. A message that only identifies a member as “at risk” leaves the provider to investigate the issue and determine what to do.
- Incomplete medication information. Claims and medical records may miss over-the-counter products, cash purchases or older prescriptions still being used at home.
- Workflow friction. Separate systems, unfamiliar communication channels and additional administrative steps make it harder for clinicians to act.
- Fragmented responsibility. Multiple clinicians may prescribe medications without seeing the full regimen. A provider may hesitate to change a medication prescribed by someone else.
- Concern about changing therapy. Providers and members may worry about symptom recurrence or other consequences of reducing or stopping a familiar medication.
- Limited clinical support. A provider may recognize a concern but need additional evidence, alternatives or resources to support deprescribing.
- Time and resource constraints. Reviewing complex regimens and coordinating follow-up compete with other clinical responsibilities.
Understanding these barriers helps MA plans design outreach that supports providers and makes the next step easier—empowering them with the details they need to improve medication use and safety for plan members.
Explore the components of an effective, proactive approach to COB and Poly-ACH. Check out our e-book for details!
How can plans support action without adding to provider workload?
Plans can reduce provider workload by delivering concise, clinically reviewed information and clear next steps through familiar communication channels.
How? Health plans can start by making messages brief, specific and actionable. A useful summary brings together the member at risk, medications involved, relevant history, potential safety concern and options for consideration. Providing this context gives the prescriber a clearer basis for decision-making and reduces the investigative work required to evaluate the concern.
Throughout the exchange, it’s imperative to support the provider’s clinical judgment. The most effective communications present a claims-based flag as an opportunity for review and invite the prescriber to confirm, refine or disagree with the recommendation based on the member’s circumstances.
For busy provider offices, the communication channel also matters. EHR-integrated messaging, when available, can bring information into a familiar workflow. Other offices may prefer phone or fax communication, while more complex concerns may benefit from pharmacist-to-prescriber consultation. Matching outreach to the practice’s preferences makes it easier for the appropriate clinician to receive, review and respond to the information.
The goal is to make the provider’s next step easier while preserving the clinical review and follow-up needed to support safer medication use.
Follow-through is equally important. Communication efforts should document the provider’s response, planned action and follow-up responsibilities. Continued data monitoring paired with additional outreach, when needed, helps the care team assess whether a concern has been addressed and respond as new risks emerge.
What does stronger provider partnership look like in practice?
Stronger partnership connects early risk identification with useful communication, clinical support and continued coordination.
For health plans, that means looking beyond whether an alert was sent to whether the appropriate clinician received it, had the information needed to evaluate it and was supported in coordinating a response.
AdhereHealth brings together predictive analytics, omnichannel outreach, clinical expertise and behavioral science–based engagement to help plans identify potential medication risks and support provider partnership. By connecting prescribers with relevant information through their preferred workflows, plans can help turn identified concerns into coordinated clinical action.
Want to strengthen provider partnerships and support safer medication use? Contact AdhereHealth today to learn more about our medication safety solutions. For additional practical insights to strengthen provider partnerships and medication safety performance, check out our webinar replay.
