In this section, you’ll find:
• Ways to improve Star ratings
• Benefits of medication adherence
• Patient outreach tips
• Closing medication gaps for patients with diabetes
• Medication Therapy Management Program
This section discusses ways to improve pharmacy measures. For a list of these measures and details surrounding them, click here.
Medication adherence is one of the main ways we can help patients improve their health and vitality.
Taking medications as prescribed helps:
Assign a dedicated staff member to manage your patients’ Star metric medication adherence outreach activities.
Your Cigna Healthcare Medicare Advantage representative can provide you with a medication adherence target list that identifies patients who:
− Have a history of poor medication adherence.
AND/OR
− Are late for a refill of the identified medication(s),
Your office medication adherence manager reaches out to targeted patients by phone. The goal is to:
− Address and document barriers to medication adherence.
− Encourage refill of the medication(s).
− Emphasize the importance of taking the medication(s) as directed.
Reach for the Stars by reaching out to patients
PCP Office + Personal Outreach = Improved Adherence
Studies have shown that when a primary care provider’s (PCP’s) office makes a personal telephone call to a patient at risk for nonadherence, medication adherence improves.
>4x More likely to refill late medications.*
>2x More likely to end the year adherent.**
*Hong M, Esse T, et al. Evaluating Success Factors of a Medication Adherence Tracker Pilot Program in Improving Part D Medication Adherence Metrics in a Medicare Advantage Plan: Importance of Provider Engagement. J Manag Care Spec Pharm, 2020 May;26(5):662-667. doi.org: 10.18553/jmcp.2020.26.5.662.
**Hong M, Esse T, et al. Evaluating Success Factors of a Medication Adherence Tracker Pilot Program in Improving Part D Medication Adherence Metrics in a Medicare Advantage Plan: Importance of Provider Engagement. J Manag Care Spec Pharm, 2020 May;26(5):662-667. doi.org: 10.18553/jmcp.2020.26.5.662.
Statin Use in Persons with Diabetes (SUPD) is an important measure affecting Star ratings. The American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines recommend moderate-to-high intensity statin therapy for primary prevention in patients ages 40–75 with diabetes.
SUPD measure definition
The percentage of patients aged 40-75 who have filled a diabetes medication two or more times and who were dispensed at least one fill of a statin medication during the measurement year.
Remember: The SUPD measure does NOT include all patients with diabetes.
Patients who control their diabetes without prescription medications or do not use their insurance coverage to pay for them.
Patients who had only one fill of diabetes medication in measurement year.
Patients who take only single ingredient products with dapagliflozin or empagliflozin for diabetes are not included.
Exclusions: Patients with the following are now excluded from the measure:
Rhabdomyolysis or myopathy
Pregnancy
Lactation and fertility
Cirrhosis
Pre-diabetes
Polycystic ovary syndrome (PCOS)
Hospice
End-stage renal disease (ESRD)
Which patients with diabetes are most likely to benefit from statin therapy?
According to the ACC/AHA, statin therapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) is strongly recommended for individuals with diabetes, aged 40–75, and those with an LDL of 70 to 189 mg/dL and without clinical ASCVD.*
What is the leading cause of death for individuals with diabetes?
ASCVD is the leading cause of morbidity and mortality for individuals with diabetes and the largest contributor to the direct and indirect cost of diabetes.*
What resources does Cigna Healthcare offer providers to help close this gap in medication therapy?
We send providers gap-in-care alerts through the RationalMed® program administered by Express Scripts. Additionally, Cigna Healthcare Medicare Provider Performance Enablement, Clinical Pharmacy, and Care Management teams work directly with providers to close SUPD gaps.
*Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 139: e1082–e1143.
What statin medications does Cigna Healthcare Medicare Advantage cover?
How can your office help?
Here’s how:
Your Cigna Healthcare Medicare Advantage representative can provide a target list that identifies patients with an open gap for a statin use measure.
Write prescriptions the way you instruct you patients to take their medications.
Encourage patents on an established maintenance medication regimen to use mail-order and 90-day supply options. (For more information, visit my.express-scripts.com/toolkit-medicare.html)
Educate your patients on the purpose of their medications and how they will make them feel.
Coordinate all prescription refills for the same time in order to prevent gaps in therapy.
Suggest patients use pillboxes and set reminders for refills.
Include the reason for taking the medication on the prescription label.
Schedule follow-up visits prior to prescriptions running out.
Your office staff can flag patients, and providers can consider prescribing a statin at the next check-up.
A Cigna Healthcare representative may contact you about your Medicare Advantage patients who could benefit from statin therapy.
The Medication Therapy Management (MTM) Program is a CMS-required component of our prescription drug plans and medical plans with prescription drug coverage.
MTM can help identify potential errors and gaps in patient care by:
Helping reduce the risk of medication errors – especially if patients have chronic conditions, take several medications, or see multiple providers.
Providing current information on proven medical practices to help providers determine the most effective treatment.
Helping patients understand conditions and medications, so providers can help patients take an active role in managing their health.
There is a Star measure that assesses the percentage of MTM-eligible patients who receive their comprehensive medication review (CMR) through their Medicare plan’s MTM program.
How can you help?
Your Cigna Healthcare Medicare Advantage representative can provide a target list that identifies patients who qualify for the MTM Program.
Your office staff can alert targeted Cigna Healthcare Medicare Advantage patients on their next visit with you, encouraging them to contact us for a complete medication review with a pharmacist at 800.625.9432.
Encourage your patients to engage in this free benefit if they qualify. You can download patient educational resources by visiting Cigna.com > For Medicare >Member Resources > Overview > Manage Medications > Medication Therapy Management.