Friday, April 24, 2020
For Medicare clients, quality drives outcomes and outcomes drive savings
Improved Star ratings for Medicare clients is a measure of Prime’s quality care and service to members.
Guidance for CMS Star ratings are new every year. This demands continuous improvement from health plans. And that’s okay, because Prime’s commitment to innovation brings new tools to the table, too.
The economic burden of chronic conditions
The prevalence of chronic conditions is especially pronounced in the Medicare population. Among people at least 65 years old, three out of four have at least one chronic condition. Nearly half have three or more.1,2
Ninety percent of the nation’s $3.5 trillion in annual health care spend goes toward treating people with chronic and mental health conditions. Programs that prevent chronic diseases, or manage their symptoms, can reduce these costs.3,4
Starting with quality and data analysis
Prime assigns each Medicare client a quality representative to assist with data analysis. This individual evaluates a range of programs using claims data and predictive analytics and prepares a customized action plan designed to boost the client’s Star ratings.
86 percent of Prime’s 1.4 million Medicare members are in health plans with a Part D rating of 4 or 5 stars
Programs target members by risk
Data evaluation and dashboards provide the information to help the team prioritize interventions by level of risk, to make the most impact. Programs cover the gamut of the health care delivery chain, from doctor to pharmacy to member.
A dedicated quality team
Each Prime Medicare client has its own team dedicated to improving its Star ratings. This dedicated focus helps Prime better understand clients’ needs and deliver positive clinical and financial outcomes for clients and their members.
1. Centers for Medicare and Medicaid Services. Evaluation of Care and Disease Management Under Medicare Advantage Contract HHSM-500-2006-0009I/TO4. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/Green_2009.pdf
2. Multack M, Noel-Miller C. Who relies on Medicare? American Association of Retired Persons Public Policy Institute. Fact Sheet 259, June, 2012. https://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/who-relies-on-medicare-factsheet-AARP-ppi-health.pdf
3. Buttorff C, Ruder T, Bauman M. Multiple Chronic Conditions in the United States pdf icon[PDF – 392 KB]external icon. Santa Monica, CA: Rand Corp.; 2017.
3. Center for Medicare & Medicaid Services. National Health Expenditures 2017 Highlights pdf icon[PDF – 74 KB]
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 30 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
Follow @Prime_PBM on Twitter.