MA Plan Credits Integrated Strategy for Three-Straight Years of Five-Star Ratings, Reports AIS Newsletter

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The May 9 issue of Atlantic Information Services’s (AIS) Drug Benefit News (DBN) offers coverage of AIS’s recent webinar on drug-related star ratings, including commentary and strategies from executives from Seattle-based Group Health Cooperative, which has consistently earned high marks.

In the final 2015 Advance Notice and Call Letter, CMS last month confirmed that its three-year quality bonus payment demonstration — which offered scaled bonus payments to Medicare Advantage plans with three or more stars — will end on Dec. 31, 2014, meaning that only MA plans with four or more stars will qualify for quality bonus payment increases going forward. The May 9 issue of Atlantic Information Services, Inc.’s (AIS) Drug Benefit News (DBN) covers advice given during AIS’s April 29 webinar on drug-related star ratings from executives at Seattle-based Group Health Cooperative, who attribute an integrated strategy for earning its HMO a summary rating of five stars for the past three years and high Part D star ratings for the CMS program’s five heavily weighted intermediate outcomes.

As both an integrated delivery system and a health plan, Group Health is able to leverage physicians, nurses and pharmacists “to all be working toward the same goal,” asserted Shirley Reitz, Pharm.D., director of pharmacy clinical services.

Through a patient-centered medical home model that it piloted in 2006 and has since implemented at all 25 of its primary care clinics, Group Health has embedded clinical pharmacists into the care team to drive outcomes. The involvement of clinical pharmacists has not only helped improve patient outcomes and thus boost Part C ratings, but pharmacists have been instrumental in addressing the Part D intermediate outcomes measures, explained Brandy Fouts, Pharm.D., Medicare clinical services coordinator.

The plan also has deployed several patient-directed strategies, including a one-time pilot specifically targeted at patients who received care in the external group practice and were either newly starting a chronic medication or had a history of nonadherence. These patients were referred to a pharmacist for counseling that focused on identifying barriers, assessing that patient’s readiness to change and offering them solutions, said Fouts. Prescribers were notified of the communication, and three months after pharmacists placed the initial phone call, patients received a follow-up call. Preliminary results based on interviews with the 103 patients contacted identified five common adherence barriers among 60% of the patients.

The most common barrier was lack of knowledge, observed Fouts. “This is really lack of knowledge about what it means to have a chronic condition or what the consequences are of not treating their chronic condition or how to use their medication,” she explained. Other common barriers were forgetfulness, denial of condition, adverse effects and health literacy.

Visit to read the article in its entirety, which includes details on more strategies Group Health has employed. For more information on the April 29 webinar, visit

About Drug Benefit News
Published biweekly, Drug Benefit News delivers timely news and proven cost management strategies for health plans, PBMs, pharmaceutical companies and employers. Coverage includes up-to-the minute news of industry consolidation, strategies for participation in exchanges, generic promotion tactics, formulary decisions, innovative benefit designs, drug pricing methodologies, PBM contracting, changes in Part D and other federal initiatives, and much more. Visit for more information.

About Atlantic Information Services
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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Jill Brown, Executive Editor
Atlantic Information Services
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