Services + Solutions | Medicare

Prime’s unique relationship with our clients enables us to drive solutions.

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Our Medicare experts have a deep understanding of this regulated segment and offer solutions that support a high degree of compliance and quality of operations. We lean forward with strategic planning for future business needs. 

Closing the ratings gap

In the Medicare industry, Star ratings are indicators of quality care and customer service. Prime uses holistic member, prescriber, and pharmacy data and analytics to uncover opportunities to help close Star ratings gaps.

For example, Prime’s GuidedHealth® program helps members and providers make better decisions about members’ health. The program uses data and analytics to help improve health outcomes, increase safety and lower total cost of care.

According to Prime internal data

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Prime’s program shows improved adherence among Medicare members

Improving drug adherence is critical to increasing Star ratings. Adherence is measured across three categories: diabetes, hypertension, and cholesterol-lowering drugs (statins). Prime offers a new Medicare proactive pharmacist program informed by a predictive model to improve drug adherence in those areas and, in turn, Star Ratings.


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Optimal drug management in action

Our dedicated team of Medicare experts includes client engagement, clinical and financial experts. Our unique Blue + Prime partnership model allows us to understand our clients’ individual market needs. We work together to determine the right mix of products and services to help lower costs, improve health outcomes, and increase Star ratings.

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Our Medicare programs get results

  • In 2020, 86% of Blue + Prime MAPD members were in plans with Part D summary ratings of 4+stars.*
  • Continued year-over-year improvement on the 3x Adherence scores (diabetes, hypertension and cholesterol)*
  • Adherence rates have improved year-over-year since 2012; one intervention showed increases as high as 1.9%**
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* Centers for Medicare and Medicaid Services, 2019
** Prime internal data