Prime Therapeutics’ proactive pharmacist calls, informed by a predictive model, improved Medicare member medication use

CMS quality categories – diabetes, hypertension, high cholesterol – focus of outreach

September 18, 2019

Eagan, Minn. – A new study from Prime Therapeutics LLC (Prime) showed Medicare members’ adherence to their medicines improved following proactive phone calls from pharmacists informed by a predictive model. The pharmacist call program focused on members with diabetes, hypertension and high cholesterol who would benefit the most from a call. Having more members who take medicines as prescribed helps increase a health plan’s Star Rating.

The Centers for Medicare & Medicaid Services (CMS) uses Star Ratings to show individuals selecting Medicare insurance the overall plan quality. Higher Star Ratings helps the plan increase plan enrollment and receive CMS bonus payments. Adherence to medicines in the diabetes, hypertension and high cholesterol drug categories is a major component of how CMS evaluates health plans’ quality.

Members receiving a pharmacist call had statistically significant higher odds of adherence from 2017 to 2018 compared to the study’s control group who did not receive a call. The increased use resulted in estimated Star Rating increases of 1.07 percentage points, on average, among the three disease states. A single percentage point increase can make the difference between a 3 to 4 or 4 to 5 Star Rating.

The targeted members were identified using a predictive model. The model initially evaluated over 400 variables including pharmacy claims history, sociodemographics, benefit design, severity of member’s illness, and long travel distance from a member’s home to their pharmacy. The pharmacist call educated members on the importance of taking their medication as prescribed and provided resources to help overcome barriers that may contribute to stopping their medication.

“The use of predictive modeling to assess the impact of our pharmacist call interventions, thereby improving medication adherence in Medicare members is new – but highly beneficial,” said Steven Champaloux, principal data scientist, Prime Therapeutics. “A phone call from a pharmacist to certain members can improve Star Ratings for health plans. It is important to use the predictive model to determine who would benefit from the call to achieve maximum effectiveness.”

The Academy of Managed Care Pharmacy (AMCP) recognized this research with a gold award. Prime researchers will present this award-winning research at AMCP Nexus Oct. 29-Nov. 1 in National Harbor, Md.

More about how Prime works with health plans to improve medication adherence among Medicare members.

More about our dedicated Medicare team that focuses on better outcomes and managing rising drug costs.

Download AMCP research poster

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