Prime links changes in adherence rates with total cost of care

Each step up in adherence links to a step down in total cost of care

Star Ratings are tied to adherence rates and specific chronic conditions. Prime wanted to understand more about the association between adherence rates and total cost of care for Star categories. Because of Prime’s connection to Blue Plans, Prime has integrated medical and pharmacy claims data and could track adherence rates to total cost of care.

Starting with a large Medicare population (over 560,000 members across 20 contracts) gave us strong cohorts to work with after applying analytic criteria. We looked at two years of data.

This study is rich with data you will not find anywhere else. It shows a statistically significant association between increasing adherence within Medicare Star Rating drug categories and lower total cost of care, as well as lower odds of hospitalizations and emergency department visits.

Every increase in adherence was associated with a decrease in total cost of care.

Each one percentage point adherence increase was associated with a cost-of-care decrease of $21 to $46 per patient per year. The specific dollar amount cost decrease varied by drug disease category. The most adherent individuals had lower annual total cost of care of between $1,353 and $3,713, depending on the drug disease category, compared to the least adherent individuals.

Findings are limited by potential healthy adherer effect.

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