Because members are more than just numbers, their individual experience matters. We’re seeing CMS emphasize this by increasing weight for measures related to member experience. In fact, while 36% of Star measures relate to member experience, they now account for 57% of a plan’s overall Star Rating.1 And the rating weight increase is significant. If the increases were applied last year, almost 20% of plans would have seen their overall Star Rating go up. Conversely, those plans that had previously earned 5-star ratings despite lower member experience scores will see a drop in their overall numbers if corrections are not made to their current strategy.
If a CMR is already a mandated part of your plan, how can it be such a catalyst for better Star Ratings?
All CMRs are not created equal, and a retail-based Medication Therapy Management (MTM)3 program provides a higher quality of CMR service to members. First, sheer convenience speaks to one of society’s most valued resources: time. 9 in 10 Americans live within five miles of a community pharmacy2 and, in most instances, no appointment is required. With 66% of adults taking five or more prescriptions regularly, a community pharmacist is not only a familiar face, but part of a routine.
Second, that familiarity builds trust. For most, the local pharmacist is already looking for cost-saving generics, administering vaccines and taking blood pressure so he/she is also well positioned to offer a personal CMR service in natural conversation and a familiar setting.
Third, the chance for disjointed messages and mismatched treatments increases when a member’s health issues are diagnosed by more than one medical professional. The community pharmacist is most often the single professional that sees the entirety of a member’s medication history, giving them the unique perspective to educate both the member and their prescribers about irreconcilable treatments and medication combinations. The 2015 Journal of Hospital Medicine showed pharmacist involvement has a positive impact on a member’s attentiveness and it decreases hospital visits.4
While there is certainly a place for call-center based care in our ever-evolving technological world, the trusted relationships between pharmacists and their patients boosts member experience unlike other avenues. Once a member experiences a CMR in the Outcomes® local pharmacist network, they are twice as likely to accept the service again.5 The CMR service offers an efficient avenue to empower patients through increased understanding of their medications as well as connect them with tools and support to effectively manage their medications—and their health. When a local pharmacist completes a CMR, they may choose to leverage the conversation to reconcile refills; set the patient up with adherence-support services, such as refill reminders; recommend appropriate OTC products; or connect them with other health-support services in their area. This becomes a service that members not only deem as essential but something they look forward to each year.
How do patients feel about their CMR experience?
Outcomes has partnered several times with health plan clients to survey members following their CMR. Consistently, 82%-85% of survey respondents rate their CMR experience highly, 4 or 5 out of 5. These surveys have been delivered through different formats to different populations in different parts of the country with services delivered by pharmacists in many different pharmacies and practice settings, but the experience remains consistently valued by members.
In addition, survey respondents often positively rate other dimensions that indicate a great experience that will drive positive outcomes. Here are some excerpts from different surveys:
• 84% found the CMR so beneficial, they would recommend a review like this to their family or friends
• 83% said they felt more confident to manage their medications
• 76% signaled action by indicating they plan to follow their pharmacist’s suggestions
A CMR experience based on the established relationship between a member and their pharmacy or pharmacist can make all the difference to a CMR and may lead to healthier outcomes ahead.
Learn more about how Outcomes can help you reach your members with valuable programs.
1 Federal Register: Medicare and Medicaid Programs; Contract Year 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly 2 The expanding role of pharmacists: A positive shift for health care (umassmed.edu) 3 Medication Therapy Management (MTM) Services, American Pharmacists Association (pharmacist.com) 4 Soon you could visit your pharmacist instead of your primary care doctor for common ailments (news5cleveland.com) 5 Network Performance. 2014 MTM Trends Report