3 Key Medication Adherence Tips

Medication adherence is a key driver of patient outcomes. Any medication therapy is ineffective if the patient cannot access or take it consistently. In addition, adherence is a triple-weighted quality measure on Medicare Advantage (MA) contracts.

Triple-weighted measures—related mainly to medication adherence, diabetes control and blood pressure control—count more towards your performance than single-weighted measures in the Centers for Medicare and Medicaid Service’s (CMS) pay-for-performance Star Ratings system. Triple-weighted measures play a critical role in a health plan’s ability to earn four or more Stars, the threshold at which practices can achieve a higher proportion of shared savings dollars and quality bonuses. 

Broadly, medication adherence is simply a patient taking their medications as prescribed. However, Medicare has a more specific definition based on the Proportion of Days Covered (PDC). Medicare expects patients to fill enough medication to cover 80 percent of the days in a year. 

To help VHAN practices improve medication adherence this year and place a greater year-round focus on this crucial quality measure, the VHAN Pharmacy Team recommends three strategies:

• Prescribe for 100 days, if possible. Many MA contracts have changed their benefit design to allow for a 100-day supply of medication. Patients will be able to visit the pharmacy less often and be able to get more doses for the same copay. Further, if patients fill three 100-day prescriptions, they will be more likely to exceed the 80% PDC threshold.
• Update prescription instructions. It’s common for providers to make dosing adjustments without updating the prescription. If a provider decreases a patient’s dose but doesn’t update the prescription, the patient won’t need to refill the prescription as often and will fall short of the 80% PDC threshold.
• Focus on annual visits. Maximize annual visits by performing medication reconciliation and updating or renewing prescriptions. This helps ensure accurate medication adherence scores and enables patients to successfully manage their health.

If your practice would like to improve your medication adherence performance, VHAN’s Care Management team can help. When you refer a patient to care management, VHAN’s team of pharmacists, social workers, and nurses can step in to provide medication reconciliation, help patients overcome barriers to filling prescriptions, and offer additional support to patients with complex health conditions. Refer a patient by visiting VHANReferral.org or calling (615) 936-2828. VHAN members can access additional pharmacy tools on VHAN Hub.