Health Plans

Hundreds of billions of dollars of unnecessary medical cost is lost annually due to medication adherence-related problems. Social determinants of health create barriers to care that significantly impede quality improvements. With billions of annual federal and state value-based care incentive dollars at stake, health plans are challenged to capture these payments.

For more than a decade, AdhereHealth has helped Medicare Advantage, managed Medicaid and Commercial plans improve health outcomes. An analysis of Medicare Advantage Part C and D measures for the 2021 contract year reveals 52 percent of experience improvement, process, and outcomes measures are anchored to medication use.

These complex quality measurement systems require technologies that engage non-adherent consumers and their providers to close care gaps.

Adhere™ is our medication-focused solution platform that uses advanced analytics to stratify consumer populations, prioritize interventions and resolve gaps in care. Adhere™ includes powerful analytics, a nationwide licensed clinical network and pharmacy home delivery to improve value-based care. AdhereHealth guarantees each non-adherent consumer’s conversion to align with health plan goals.

Learn More

Explore proven strategies to help your health plan optimize Medicare Advantage Star Ratings when you download Raising the Bar on CAHPS Performance.

Resolve™

A one-of-a-kind solution for health plan consumer engagement

Medication adherence dominates many value-based care initiatives, such as Medicare Advantage Star Ratings. With over 50% of Star Ratings weighting based on medication adherence related quality measures, Resolve uniquely delivers guaranteed fees for each consumer conversion.

Offered as either a tech-enabled service that combines the mind of a clinician with the heart of a social worker, or a fully configurable SaaS-based solution, Resolve is a comprehensive offering within the Adhere™ platform that analyzes near real-time data from dozens of sources within a streamlined intelligent clinical workflow to maximize health plan outcomes.

Resolve delivers improved population health one consumer at a time through understanding each individual’s social determinants of health, gaining commitment to improve quality, coordinating with the provider care team and leveraging real-time adherence surveillance.

OptimizeMTM™

Configurable medication therapy management SaaS and tech-enabled services.

Value-based care has adopted MTM solutions for both government-sponsored incentives or commercial employer medical cost reduction initiatives.

AdhereHealth’s MTM solution is available as a software-as-a-service (SaaS) or tech-enabled service. OptimizeMTM™ addresses client goals and regulatory required needs by incorporating predictive Stratify™ analytics into our P3Link™ clinical decision support tool. The solution structures all client and regulatory requirements of consumer eligibility, data validation, offer letter generation and fulfillment and end-of-year reporting requirements.

OptimizeMTM™ addresses care gaps associated with HEDIS® (HEDIS® is a registered trademark of the National Committee for Quality Assurance [NCQA]), Part C and Part D measures with real-time analysis based on historical claims data and consumer input.

Digital Pharmacy Services

Designed for patients of all acuity levels and the health plans that serve them, the Adhere Platform Digital Pharmacy Services support medication adherence in tandem with AdhereRx, an AdhereHealth digital pharmacy with compliance packaging capabilities uniquely designed to serve high-risk, high-cost patients with social determinants of health (SDOH) barriers that cause habitual medication nonadherence. From mail order to PillPack by Amazon Pharmacy to AdhereRx™, AdhereHealth supports medication adherence in a vertically integrated system.