Star Measure — 2017 Medication Adherence for Diabetic Care
Topic Explanation Measure Type Dynamic Star Measure Percent of Medicare Advantage members taking diabetic medication who fill their prescription often enough to cover 80% or more of the time they are Description of the Measure supposed to be taking the medication. Diabetes medications include biguanides, sulfonylureas, thiazolidinediones, DPP-IV inhibitors, incretin mimetics, meglitinides and SGLT2 inhibitors. Members must be 18 years and older with at least two fills of medication across any of the drug class during the measurement period. Exclusions: • Members on insulin • Members with End Stage Renal Disease Eligible Population • Members are identified as diabetic by claims data. If you believe a member may be erroneously identified as a diabetic, document in the member’s medical record that the member is not diabetic. They will remain in the eligible population until claims data identifying them as diabetic is not received in the measurement year or the year prior to the measurement year Members who have an 80% or over fill rate with their diabetic Compliant Member medication The claim is only captured via a pharmacy claim. The dispensing pharmacist generates the claim as the claim is processed at the point How to Submit to Highmark Inc. of sale. Adherence is reflected when the member picks up the medication. There is no supplemental data source for measures requiring pharmacy claims
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Topic Explanation
• Identify all patients who are prescribed medication for diabetes
• Discuss with members the benefits of adhering to medication − Nurse/Physician/Medical assistant/Physician extender • Prep chart to ensure that provider discusses ongoing compliance
• Utilize medication adherence report to identify those trending poorly (percent) on compliance Best Practices • Provide ongoing member outreach to those showing as non-compliant
• Identify reason for non-compliance and attempt to resolve
• Schedule follow-up visits for non-compliant patient to educate
• Discourage “pill cutting” rather than taking medication as prescribed
• Be proactive. Evaluate practice processes for opportunities to close gaps every time the patient is seen rather than reacting to gap closure reports Encourage the member to utilize their insurance card, as this may help to identify other services that may be helpful to the member. Samples and Other paying in cash will not generate an insurance claim, and Highmark will not gain credit for the adherence measure. These patients will appear as non- compliant with the measure.
Key Additional Resources
Additional information can be found on the Provider Resource Center, Medicare Advantage Stars section.
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