June 10, 2015
A new Star Ratings measure is coming. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) revealed that it will add a new quality measure to the 2016 Star Ratings: a metric for the completion rate of Comprehensive Medication Reviews (CMRs) within the Medication Therapy Management (MTM) program.
Although the new measure won’t go into effect until January 1, 2016, pharmacies need to start preparing now.
“It’s very important for pharmacists to understand that while this is a new metric coming out, they need to be ahead of the game,” said Elliott Sogol, Ph.D, R.Ph., F.A.Ph.A, vice president of professional relations for Pharmacy Quality Solutions, a quality assessment service company. “You don’t want to play catch up.”
Even though CMR completion rates will only be given a weight of “1” in the Star Ratings, you don’t want to ignore them. They’re intertwined with other metrics, including medication adherence and high-risk medications, so their impact will be much greater. “Besides getting credit for MTM, you’ll be improving your other metrics, as well,” Sogol said.
One challenge will be getting patients to opt into the service. “Your score factors in all eligible patients, even if they refuse the service,” Sogol said. “You’re held responsible for getting patients to participate. As a health care professional, your role is to help patients fully understand the importance of this service.”
Even though Star Ratings are currently only assigned to health plans and not to pharmacies, your performance on these metrics can—and does—matter.
Health plans are using Star Ratings to determine which pharmacies to include in their quality-based networks. “It used to always be cost-based but now it’s shifting to be a cost and quality component,” Sogol said.
“The score the pharmacy receives today will ultimately influence how well they do within a given preferred network or quality network moving forward,” he said. “Starting next year, these quality metrics will be widely utilized to determine who belongs in preferred or quality networks.”
Pharmacists create positive outcomes for patients and the health care system—and CMS has noticed. “CMS has seen that when patients have CMR services, they see a lower health care cost down the line,” Sogol said. “Pharmacies impact the health plan summary score Star Rating by almost 50 percent today. And, the more pharmacists provide this service, the more overall health care expenditures decrease.”
“I think moving forward pharmacies will gain more and more opportunities to practice at the top of their license, and this is one of them,” Sogol said. “Working one-on-one with the patient, really focusing on their specific health care needs around medication use and management, and helping them understand the importance of all of this—this is what it means to be a pharmacist.”