Retail Pharmacist: How Can Retail Pharmacists Help Health Plans with CMS Star Ratings Measures?

Medicare star rating program was established in the year 2007 by the CMS (Centers for Medicare and Medicaid Services) with the aim of enumerating quality measures for all part D health plans and for Medicare beneficiaries to use when making important decisions about healthcare enrollment.

Qualities Being Tracked

For a number of years, CMS has been evaluating all part D prescription medicine plans using a Star Rating program. Medicare treatment drug program receive a summary Star Rating on quality according to their performance across fifteen individual measures. Five of these measures are related to medication management and its use, and they weigh heavily as they account for almost half of the plan’s part D summary rating. Part D program are highly focused on tracking patient and quality outcome to make sure that the pharmacies in their locality deliver the best patient care.

The Star Rating program’s 2 medication safety measures follow high risk medication among the elderly and the appropriate medication of blood pressure in people with Diabetes. Its 3 medication adherence measures follow oral Diabetes treatment, blood pressure – renin-angiotensin system antagonist, and cholesterol treatment – statins. In addition, CMS evaluates treatment drug plans on different display measures such as metric on drug-drug interaction, use of atypical antipsychotics as well as excessive doses of oral Diabetes treatments in nursing home patients.

The Work of Retail Pharmacies

First, they need to understand how they’re performing on this Star Rating measure and where they are placed among the competitors. With this information, they are able to identify their weaknesses as well as their strengths, and thus improve their scores through various staff training programs. EQuIPP management platform makes this possible. It is a performance information management program which makes unbiased, benchmarked performance information available to community pharmacy organization and other health plans.

Health plans present their prescription states data to the EQuIPP platform where it is calculated for the Star Rating purposes and then realized to the pharmacies through website.EQuIPP offers a benchmark for the measurement of the quality of different medication use, makes the information easy to understand and access. Through this, it offers an environment where community pharmacies and medication drug plans can interact so as to progress the quality of medication use.

Through Cardinal Health project,

  • Retail pharmacists can track their score on the CMS Star Measures and receive regularly updates on their performance.
  • They can access different benchmarks so as to compare themselves against then standard or average scores for their state and nation.
  • Retail Pharmacists can also access educational materials about the Medicare Stars as well as quality improvement programs and be linked to other data for clinical quality improvement.
  • They can also improve their performance on important Star Rating measures through additional Cardinal Health programs.

Community pharmacies have been known to serve as lynchpin of accessible, convenient, patient focused care centers in our neighborhoods and in the community they serve. However, as these plans advances, more effort is being focused on pay for performance and pay for quality services, and thus it’s very important for retail pharmacists to have access to new tools which can help them show the impact their health care plan has on their patient outcomes and even understand where they need to improve.