
Contributor: The Quintuple Aim: How Medication Adherence Can Be a Lever for Improved Health Equity
Medicare Advantage health plans can become more equitable and value driven by addressing common socioeconomic barriers in medication adherence.
Over time, the Triple Aim expanded into the Quadruple Aim, which adds the pillar of improved provider experiences in an effort to combat the widespread burnout and staffing shortages that make it challenging to achieve the other items on the list.
Last year, after the COVID-19 pandemic taught us more about what it really takes to create the efficient, cost-effective, person-centered health care system of the future, a fifth pillar, health equity, was added to create the
CMS Follows Suit, Inserting Heath Equity Index into Star Ratings
This new focus on health equity was quickly embraced by CMS. On April 5, 2023, CMS issued a Final Rule establishing the creation of a
The HEI score will measure performance years 2024 and 2025, leading to the first rating in 2027. Initially, plans will be scrutinized on how they provide care for MA Part C and Part D members in 3 SRF categories (members with low-income subsidies, dual eligibility, and disabled status). Performance buckets will be divided into thirds, with plans in the top third on a given measure rated 1 point (included measures are due to be announced annually). Plans in the middle third will get 0 points, while those in the bottom bracket will get –1 point. CMS will then aggregate the scores across included measures to create a weighted overall score, which will be applied to the Star Ratings calculations. Plans must have a total score greater than 0 to qualify for any QBP incentive. Performing well on the HEI measure is imperative to MA plans’ ability to provide health care benefits that improve health outcomes and patient experiences, but also to continue providing
What is Health Equity?
Health equity has become an increasingly familiar term, but it’s important for health plans to be clear on exactly what the term means. CMS
To this end, the health care system continues to have its work cut out for it. Disparities in access and outcomes are common, with BIPOC (Black, Indigenous, People of Color) communities bearing disproportionate burdens of disease that contribute to poor quality of life and
And because communities with greater socioeconomic challenges are
Mapping medication adherence to the goals of the Quintuple Aim
Appropriate medication adherence is an indicator that other health-related activities are on track. If a person is meeting recommended medication adherence thresholds by having access to their prescriptions at least 80% of the time, it typically means they are able to access care, afford and acquire their medications, and understand the process and importance of taking them as recommended.
In fact, improved medication adherence can be mapped back directly to each component of the Quintuple Aim:
Better outcomes for patients—Study after study, both
Reduced spending for the health care system—Better adherence leads to fewer health complications, which leads to lower spending on emergency department care, hospitalizations, and specialty care. In a recent study of low-income people with 1 chronic condition, such as diabetes, patients with the lowest adherence (less than 25% of days covered) had $3152/year higher Medicare costs than patients with 95% or more days covered. A similar pattern held true for people with multiple chronic conditions.
Better experiences for patients—Fewer health emergencies and lower costs from improved adherence typically translate to more positive experiences for patients and their loved ones. For MA plans, the success of these efforts is often reflected in the CAHPS survey, one of the key
Better experiences for health care providers—The availability of
With improvements to available data, providers gain access to key information that can help reduce the likelihood of job dissatisfaction and
Improved health equity—A coordinated effort to improve medication adherence, particularly among communities with greater socioeconomic challenges, could help close the gaps in experiences and outcomes in these populations. Poor health outcomes and chronic disease development are
Ensuring access to medications for these populations and providing the socioeconomic support necessary to foster sustained adherence to recommended care plans could significantly decrease health disparities and improve outcomes for entire communities.
Medication adherence as a fulcrum for achieving the Quintuple Aim
A coordinated effort to improve medication adherence, particularly among communities with greater socioeconomic challenges, could help close the gaps in experiences and health outcomes in these populations. Health plans are in a unique position to affect change in this area—and they have strong incentives to take action on behalf of their members.
Star Ratings measures tied to medication adherence are triple weighted, and high performance on the CAHPS member satisfaction survey is
By successfully leveraging proven strategies to zero in on medication adherence, plans can improve their performance on the HEI measure, increase their odds of crossing the crucial 4.0-Star threshold that unlocks significant QBP incentive opportunities, and attracts members shopping for the best possible care.
By taking the lead in addressing the root causes of medication adherence, many of which lie in common socioeconomic barriers, MA health plans can take action on the move to a more equitable, value-driven health care system while concurrently achieving their own goals and longevity.
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