Optum’s Stars Performance Improvement Solution
Helping Medicare Advantage Plans Enhance Quality of Care
Star ratings are a CMS initiative to improve the quality of care
delivered by plans serving Medicare beneficiaries; plans are rated on a
5-star basis. While there is broad acceptance of the importance of the
stars initiative, many plans have struggled to improve their scores due
its complexity and evolving measurements involved.
Stars focuses on six domains: organization and strategy, operations strategy,
provider engagement, member engagement, data and reporting, and medication
adherence. Optum’s Stars Performance Improvement Solution helps plans develop
their stars governance and structure, develop operational processes, engage
26%
The percentage of
Medicare Advantage
enrollees covered by
contracts rated as above
average or excellent (4 or
more stars).
providers and members to enhance participation, and gain access to performance
—Kaiser Family Foundation, Feb. 2011
data. Medication adherence is recognized as of the most important areas in
improving health outcomes. As a result, CMS has added three adherence quality
measures within the five-star rating system that are weighted higher than the
operational measures. These focus on three key health issues: diabetes, high
cholesterol, and hypertension.
$3.1 billion
The approximate
amount Medicare
Advantage plans are
projected to receive in
2012.
To move toward better quality ratings, plans need to fully
understand the basic tenets of the star program, select a
customized approach to identifying their core capabilities,
establish best practices, and determine how to improve lagging
scores on specific star quality measures
—Centers for Disease Control and Prevention
—Preparing for star ratings in 2012, Optum
Medication Adherence
Optum has brought together its consulting team, proven tools and analytics, and
integrated products and services to help Medicare Advantage Plans improve their star
ratings. Optum’s evidence-based, technology-driven Medication Adherence solution
addresses medication non-adherence to oral diabetes, cholesterol, and hypertension
Continued
53
The number of quality
measures the star
system considers, 36 for
Part C and 17 for Part 2.
—Preparing for star ratings in 2012, Optum
medications in the Medicare population by maintaining adherence and addressing nonadherence to Rx maintenance therapies. It achieves this by providing tailored support
directly to members that helps to identify and remove barriers, and thereby prevents
gaps in care.
The approach begins by identifying and engaging patients that are at risk for nonadherence via its Drug Adherence Index (see DAI case study). Once these patients are
identified they are contacted through a face-to-face discussion, email, or letter. Services
such as a Nurse Line or health coaching are offered to remove the barriers to adherence.
Prescriptions are then tracked and reminder and off-therapy calls are made, Optum
captures and reports on the proportion of days covered and conducts an outcomes
assessment that incorporates clinical, humanistic, and economic factors.
By engaging patients and providers and removing barriers to adherence, plans realize
better adherence levels and, consequently, improved star ratings. As a whole, the
health care system benefits through health care cost reduction, along with improved
clinical outcomes.
© 2012 Optum, Inc. All rights reserved. OA 100-8406