Scientific Poster Session I - Clinical Pharmacy Forum

Abstract

Ascension, a nonprofit health system and second largest system in the US, established a centralized national pharmacy team for multiple Medicare Advantage plans in three (3) markets with approximately 59,000 covered lives. Five pharmacy technicians (5 FTEs) provided proactive telephonic outreach targeting members with a Proportion of Days Covered (PDC) less than 90% who were receiving medications for diabetes, hypertension, or cholesterol. Medicare Advantage star rating of four stars or above was determined as the goal to achieve contract requirements for financial incentives based on quality and performance.

March 1, 2023 the team began accessing plan claims data to identify members meeting criteria for outreach. A telephonic outreach was conducted if indicated after reviewing additional medication information in the local electronic health record.

Justification/Documentation:

6,437 patients were outreached by June 1, 2023 with a 22% contact rate. 67% of patients contacted received a refill and 25% were converted to 90 day fills. The most common barriers to patients refilling medications on time were setting up refills, forgetting to take medications, and medication cost. Pharmacy technicians were able to assist with removing these barriers to improve medication adherence.

With the achievement of four stars, a total of $21.6M additional funding would be earned based on plan contracts. Medication adherence is estimated to contribute 20% ($4.3M) of the overall stars rating based on each of the three measures being triple weighted. Pharmacy technician staffing expenses are $284K annually.

Adaptability: This program is applicable to any entity serving patients covered by Medicare Advantage plans.

Significance: Medication adherence measures are triple weighted metrics and a key strategy to improve Quality Star ratings for value based contracts . Utilizing pharmacy technicians to remove barriers and facilitate medication refills provides support to achieving the goal of an overall four star or above rating.

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