Best Practices
      Back to home
      1. Knowledge Base
      2. MTM Workflow, Best Practices, Guides & FAQs
      3. Best Practices

      Best Practices for Star Rating-related MTM Services

      What are Star Ratings?

      The Centers for Medicare and Medicaid (CMS) have established Star Ratings to monitor the quality of Medicare Part D plans. Based on their annual ratings, plans face rewards, such as quality bonus payments or marketing advantages, and consequences, such as potential loss of members. 

      Why are Medicare Star Ratings important for pharmacies?

      Star Ratings for Medicare plans—as well as other quality measure systems—present a significant opportunity for pharmacists to help patients, earn revenue for professional services and demonstrate value to healthcare payers. 

       

      Through MTM services, pharmacists can directly impact several Star Rating measures: 

      • Completion Rate for Comprehensive Medication Reviews (Part D) 
      • Part D Patient Safety measures: 
        • Adherence for diabetes medications: % of patients whose adherence rate for diabetes medications is ≥80%
          • Classes: biguanides, DPP-IV inhibitors, GLP-1 agonists, meglitinides, SGLT2 inhibitors, sulfonylureas, TZDs
          • Patients taking insulin are excluded from this measure 

        • Adherence for hypertension (RAS antagonists): % of patients whose adherence rate for RAS antagonists is ≥80% 

          • Patients taking Entresto are excluded from this measure 
        • Adherence for cholesterol (statins): % of patients whose adherence rate for RAS statins is ≥80% 
        • Statin Use in Persons with Diabetes: % of patients with diabetes between the ages of 40-75 that receive statin therapy 
        • Polypharmacy for anticholinergics: (Display measure only) % of patients ≥ 65 years with concurrent use of two or more unique anticholinergic medications 
        • Polypharmacy for central nervous system-active medications: (Display measure only)  % of patients ≥ 65 years with concurrent use of three or more unique CNS-active medications 
        • Concurrent use of opioids and benzodiazepines: (Display measure only)  % of patients ≥ 18 years with concurrent use of prescription opioids and benzodiazepines 

      Best Practices

      Adherence Patient Consultation for Diabetes, RAS Antagonists, Statins 

      Assess appropriateness of TIP
      • Determine if the patient still taking this medication or another in the same class
      Initiating conversation with the patient 
      • Follow the Drug Adherence Workup (DRAW) Tool
      • Use open-ended questions: “What is this treating?” or “How are you taking…?”
      Reinforcement with patient
      • Review purpose of the medication
      • Address knowledge deficits regarding medication
      Strategies to improve adherence
      • Recommend an extended day supply (e.g., 100-day or 90-day)
      • Encourage the patient to enroll in an auto-fill program
      • Suggest reminder tools such as alarms, a specific storage place for medication

      Prescriber Consultation for Polypharmacy/COB/SUPD

      Assess appropriateness of TIP
      • Determine if the patient is still taking the concurrent polypharmacy medications or if the gap in therapy still exists
      • Review potential contraindications to recommended therapy (e.g., renal dysfunction, previous adverse event)
      Leverage relationship with prescribers
      • Offer to complete in-service with local clinic(s)
      • Note prescriber preferences for communication (fax, phone, message with the nurse)
      Making your recommendation
      • Be specific with therapy recommendations; rather than stating patient should be on cholesterol therapy, include suggested drug and dosing (e.g., atorvastatin 40 mg once daily in the evening)
      • Keep it concise
      • Avoid non-critical phrases, such as “…if appropriate” or “as you know…”
      • Support with relevant clinical guidelines, studies, etc. (Select Prescriber Fax from the left side menu of the patient’s profile to see suggested verbiage for TIP-related interventions)

      Comprehensive Medication Review (CMR) 

      Offering the CMR service

        • Assume acceptance by offering a choice of time instead of a yes/no question: 
          • Use: “The pharmacist would like to talk with you about your medications. Are you available now?”  
          • If the patient is unavailable, ask for a specific time: “How about Tuesday at 2 PM?” 
          • Avoid: “Would you like to schedule a CMR?” 
        • If the patient is not able to be reached by phone, coordinate the CMR with an upcoming refill or immunization. 

        Conducting the CMR 

        • Review any pending TIPs for discussion points. 
        • Use open-ended questions that invite explanation and discussion: 
          • “What is this treating?” 
          • “How are you taking…?” 
          • “What concerns do you have?” 
          • “How do you feel?” 
        • Check administration technique: inhalers, diabetic medications, etc. 
        • Look for physical indicators of disease states not in control/adverse reactions.