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. In 2019, approximately 50 percent of the Medicare Advantage Star Ratings will be weighted on medication adherence-related quality measures.
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.
With AdhereHealth’s Pharmacy at Home™ solutions, consumers can receive their medications at their doorstep. Pharmacy at Home™ includes real-time medication synchronization with AdhereHealth’s pharmacy solution partners. This includes AdhereHealth’s pharmacy, AdhereRx™, which provides home-delivered pharmacy to high-acuity consumers who benefit from ongoing medication counseling for polypharmacy management. AdhereHealth also partners with a national compliance packaging pharmacy for multi-dose adherence sorting.
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. Using dozens of data sources, AdhereHealth’s clinicians leverage expert clinical workflow tools to guide telephonic and digital consumer dialogue regarding their medication adherence problems. 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.
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.
Stratify™ predictive analytics identify medication adherence and care assessment gaps using comparative benchmarks that support targeted consumer and provider engagement.
Quantify™ builds actionable client-specific scenario modeling for value-based care incentive structures and incorporates Stratify™ analytics to achieve targeted outcomes.
P3Link™ is a regulatory compliant clinical workflow for Medication Therapy Management (MTM) that uses Stratify™ analytics to guide interventions.
QiLink™ is a clinical workflow using decision support to guide gap closure for clinical and non-clinical interventions with consumers and providers using Stratify™ analytics.
Discern™ is a business analytics solution that provides real-time client data visualization of outcomes and program performance.