Our ever evolving healthcare system continues to undergo significant changes from year to year. From the development of accountable care organizations to the implementation of patient-centered medical homes, reimbursement for services has transitioned to an outcomes based model.  Patient-centered initiatives reward healthcare plans and practitioners for delivering high quality patient care across the spectrum of healthcare environments while emphasizing the importance of collaboration and communication among the healthcare team.

The Centers for Medicare and Medicaid Services (CMS) developed a Star Ratings system in 2007 to help patients select a health care plan. Over time, updates have been made to the Star Ratings system to define and measure the quality of health plans and patient-centered care in various health care settings.  Star ratings consist of a five-point scale and evaluate healthcare performance based on outcome, patient experience, access, and process measurements.1  Medicare Advantage and Medicare Part D prescription plans are included in these Star Ratings assessments. These plans are evaluated on patient safety and medication adherence related performance measurements (listed below), along with the completion of a medication therapy management comprehensive medication review.

Medication Related Star Ratings Categories

– High Risk Medication Use (Beer’s List)

– Adherence for Diabetes Medications (Oral)

– Adherence for Hypertension Medications (Renin-Angiotensin System (RAS) Antagonists)

– Adherence for Cholesterol Medications (HMG-CoA Reductase Inhibitors [Statins])

Poor patient performance in these categories ultimately leads to low Star Ratings for health plans and reduced reimbursement for provided services.  As a response to this shift in patient care, health plans are turning to health care providers to help achieve these goals and improve the quality of care provided to patients.

Take a moment to review the following information and test your medication related Star Ratings preparedness for managing your patients.