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Medicare Medication Adherence and Star Ratings Importance

Date: 05/27/20

Star Ratings and Medication Adherence

Star Ratings were created by the Centers for Medicare & Medicaid Services (CMS) to provide quality and performance information to help Medicare beneficiaries choose a plan. Star Ratings range from 1 to 5 (lowest to highest) and reflect the experiences of members regarding the health and drug services they’ve received. They apply to both Medicare Part C (medical plan) and Part D (pharmacy plan).

Why medication adherence matters as related to Star Ratings:

  • Medication adherence is 33% of the total score for Part D Star Ratings and is measured by adherence to diabetic medications (insulin excluded), ACEi/ARB’s, and statin medications.1 These adherence measure scores rate among the lower half compared to the other Star Rating measures, meaning there is much room for improvement. Adherence is measured by the percentage of days that a patient has enough medications to cover a set period of time.
  • Poor patient adherence to medications for chronic conditions often leads to worse clinical outcomes, more readmissions, and a lower quality of life. Patient adherence requires a multi-disciplinary approach from healthcare professionals such as pharmacists and nurses. However, often overlooked is how large of an impact physicians can have on adherence. In the last 6 months, only 50% of members were reminded about refills and only 33% were reminded to take medications.2 By proactively sending reminders for refills of medications, and offering 90-day supplies, adherence can improve and lessen the burden on patients. The complexity of a medication plan should also take into account the patient’s physical and mental capacities and  adhere to them. This is especially true for Medicare-eligible members over 65 years old.3
  • Patient satisfaction relating to the physician-patient relationship also directly influences and improves medication adherence.3 Adherence rates ultimately depend on a patient’s agreement and ability to adhere to physician recommendations. Higher patient satisfaction is 1.2 times more likely to lead to adherence.4 Purposefully applying patient-centered communication behaviors can further improve patients’ perceptions. Using good manners, exuding confidence, and involving the patient all helps decrease the barriers between older adults and physicians.3,4 This increases overall patient satisfaction and makes patients more likely to be engaged during consultations.

Providers can help improve medication adherence through patient support and understanding. Better medication adherence has lasting effects on better health outcomes and is reflected in improved CMS Star Ratings.

1. Centers for Medicare & Medicaid Services, Medicare 2020 Part C & D Star Ratings Technical Notes, October 1, 2019.
2. Centers for Medicare & Medicaid Services, Medicare 2020 Part C & D Display Measure Technical Notes, December 9, 2019.
3. Yap AF, Thirumoorthy T, and Kwan YH. Systematic review of the barriers affecting medication adherence in older adults. Geriatr Gerontol Int. 2016;16:1093-1101.
4. Nasir NM, Ariffin F, and Yasin SM. Physician-patient interaction satisfaction and its influence on medication adherence and type-2 diabetic control in a primary care setting. Med J Malaysia. 2018;73(3):163-169.