21 Prime Medicare contracts earn quality bonuses

CMS releases its latest Star Ratings: a record number of Prime Medicare contracts earn quality bonus payments from getting a 4+ Star Rating

October 26, 2020

The 2021 Star ratings were recently released by the Centers for Medicare & Medicaid Services (CMS). A record 21 Prime-supported Medicare contracts earned 4 Stars or more in the ratings released by CMS. This makes them eligible to receive a quality bonus payment.

“These results highlight how Prime is making health care more affordable for members,” says Ben Poehling, vice president, quality and performance programs. “The payments are worth hundreds of millions of dollars to our health plan clients to help them better serve their members.”

These results mean that nearly 80 percent of our Medicare Advantage Prescription Drug (MAPD) members are covered by a plan with an overall rating of 4 or more Stars.

Stars and total drug management

Star ratings have up to 44 measures that combine for one rating:

  • Part C measures mostly the health plan and medical benefit
  • Part D measures the drug benefit

As a pharmacy benefit manager, Prime influences many of the Part D measures reflecting:

  • Operations
  • Customer experience
  • Medication adherence

Prime also has influence over some of the Part C measures. Prime’s total drug management approach gives our Medicare clients an advantage.

Continuous improvement

CMS evaluates performance data each year and may adjust the measures for all metrics. This makes it more challenging to earn higher Star ratings.

“We have a strong foundation,” explains Ben Poehling. “Our adherence programs are clinically sound and validated by research. Our operations are becoming industry-leading. We build on these strengths every year. CMS can raise the bar, and here at Prime, we’ll keep innovating,” he said.

Prime has delivered year-over-year improvement on adherence scores for the big three chronic conditions CMS follows (diabetes, high blood pressure and high cholesterol). And overall adherence rates have improved year-over-year since 2012.

Prime continues to innovate with our Blue Plan clients providing products and services that deliver improved quality to members.

Take a look at some of the award-winning research behind these products. SmartAdherence™ Missed Refill Program, lower cost share generics and Quality-Based Network. And you’ll see how Prime is helping to make health care work better.

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