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A sophisticated technology platform focuses on data-driven outreach to consumers and their doctors to advance value-based care programs such as Medicare Advantage Star Ratings and managed Medicaid pay for performance. Given the growing importance of positive consumer experiences for Star Ratings and the common goal of avoiding abrasion issues, your technology solution should function like a customer relationship management system (CRM) that optimizes consumer engagements by using available data. Yet managed care organizations traditionally take a transactional approach to outreach by using generic spreadsheets, lists, and antiquated case management tools that don’t allow for ongoing purpose-driven momentum on quality improvement to support overcoming social determinants of health (SDOH), medication adherence and outcomes.
In a recent blog, we highlighted the value of using a single smart workflow to perform risk-based targeting, stratification and intelligent clinical workflow through technology. In this post, we’ll outline the benefits of using a CRM technology to advance quality and medication adherence. With the advent of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) being four times (4xs) weighted for Medicare Advantage beginning in the 2021 contract year, it will be very important for plans to emphasize positive consumer experiences in all aspects of engagement.
Consumers with medication adherence issues inevitably have a variety of SDOH issues. Overcoming these barriers to care will likely require multiple consumer touchpoints to create an environment that generates quality momentum from incremental steps towards gap closure. Consider the consumer’s point of view with a Maslow Hierarchy of Needs – for Healthcare as an approach – does the consumer have access to food, water, shelter, health-related transportation, providers, and pharmacy? Does the consumer have adequate health literacy to ensure a general understanding of how or why to improve their health? Does the consumer have a solid understanding of their health plan’s benefits or the availability of community social programs such as Aunt Bertha, The Social Care Network? Certainly, common spreadsheets, database management systems, and case management tools do not have these capabilities.
Investing in a CRM tool that encompasses the consumer’s latest pharmacy, medical, eligibility, Healthcare Effectiveness Data and Information Set (HEDIS®) and SDOH data in a meaningful stratification is critical. Thereupon, using these analytics in an intelligent clinical workflow CRM software can enable the consumer to be geared towards necessary value-based gap closure and ultimately better health outcomes.
Medication Synchronization and Direct Pharmacy Enrollment Integration
As SDOH-related barriers are resolved, ensuring consumers have access to a pharmacy that meets their needs is key to getting them to regularly adhere to their medication protocols. To optimize both the consumer experience and medication adherence, clinical engagement that provides medication synchronization, description of health plan pharmacy benefits and direct enrollment is ideal.
Consumers benefit from a variety of pharmacy options, such as those listed below, as their personal situations will guide their decision-making.
- Mail Order: Ideal for lower maintenance, lower risk consumers; 90-day medication supplies are sent to the home via common (FedEx, UPS) courier
- Adherence/Compliance Packaging: Ideal for medium-risk consumers with 4-5 prescribed medications daily, potentially with different dosage schedules throughout the day or week; PillPack by Amazon Pharmacy offers a best-in-class consumer experience with 30-day medication supplies sent to the home via common (FedEx, UPS) courier
- Complex Cases: Ideal for higher-risk consumers with a more complex medication routine and/or SDOH issues; average of 6 or more prescribed medications daily with frequent regiment changes requiring ongoing coordination of care with providers; AdhereRx is best suited for these individuals, who represent less than 5% of the consumer population; 30-day medication supplies are sent to the home via private HIPAA-certified couriers; and monthly medication reviews with clinicians are completed proactively to ensure barriers of care are addressed
With a consumer-focused technology solution, clinicians can use advanced intelligent clinical workflow software that leverages analytics from multiple sources to drive better adherence and outcomes. For more insights about improving medication adherence through technology, subscribe to our blog to receive updates as soon as they’re available.