CMS Star Ratings Update – and What it Means For Your Pharmacy!

13 Nov

CMS Star Ratings Update – and What it Means For Your Pharmacy!

On October 8th, CMS published their annual update to the Star Ratings Technical Notes for Medicare Parts C & D. This update sets the new thresholds and roadmap for Medicare Plan Sponsors in 2021.

While these 2021 updates are not directly meant for pharmacies, they do include several updates that can have an impact on pharmacies.

What your pharmacy should know about 2021 Star Ratings

  • First – pharmacies don’t actually have Star Ratings! The CMS Star Ratings Program is designated for Medicare Plan Sponsors. Pharmacists managing medication use can impact several quality measures that are included with part of the Star Ratings assessment. These measures are some of the assessments you may see in EQuIPP®, other platforms, or in performance contacts.
  • Another year, more improvement! The performance scores or thresholds for most quality measures in the Star Ratings have increased yet again. This indication means that industry-wide performance scores are 1.) Still improving; and 2.) That CMS is indicating there is still room for improvement with these measures.
  • The 2021 Star Ratings do not include any new measures, but there are some changes to how measures are weighted and there are changes to the Display page. The “Statin Use in Persons” with Diabetes measure is more heavily weighted, but that should revert to a single weighted measure for 2022.

How your pharmacy can be successful in 2021

While the notes above mention some high-level changes to the CMS Star Ratings Program, there is a process that pharmacies should consider in order to be as successful as possible with 2021 performance programs.

  • Know your contracts
    • When logging into EQuIPP®, you see your pharmacy’s overall performance score. However, performance programs with a payer are typically only going to focus on your pharmacy or pharmacy network’s score for that payer! So, what can you do to make sure you are aligned for success?
    • Check out the My Programs tab in EQuIPP®, if available. Some payers will list specific program details here along with your pharmacy scores.
    • From your main screen in EQuIPP®, click on the “Analyze Performance” button for each measure and then scroll down to the “Quality Improvement Programs” table to see your pharmacy patient count and performance score for different programs.
    • Know your contracts! Work with your PSAO or identify the measures that influence each contract’s performance program. Your pharmacy should prioritize measures in the programs that are impacting your reimbursement.
  • 6 month or Year-to-Date scores?
    • The default view in EQuIPP® is a rolling 6-month period. However, most performance programs track Year-to-Date (YTD) performance periods or the full calendar year (January – December). My recommendation is that you should almost always be using Year-to-Date scores, to maximize how you can use this information.
  • Education, Training, & Maximizing your potential
    • Use the Resources and FAQ tabs in EQuIPP® to learn about the measures and how you can improve performance. Also, check out our YouTube page for quick tutorials on how to use these measures.
    • Work as a team! Use all your staff members to help improve adherence initiatives. Of course, clinical efforts can only be managed by a pharmacist. But, consider how your technicians or interns can help with other tasks that help improve adherence!

Your pharmacy should be checking EQuIPP® regularly (at least once a month). Our team will routinely provide suggestions and tips that will help your pharmacy understand the measures, create an action plan, and optimize your performance scores!

In the meantime, we highly recommend the following resources from the EQuIPP®  Educational Video Library, located in the Resources Tab in EQuIPP® or on YouTube:

If your pharmacy needs to confirm how to access EQuIPP®, or if you have any questions about the data for your pharmacy – contact us directly! Email or “click” on the EQuIPP® Support Link at the bottom corner of your EQuIPP® dashboard.

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Nick Dorich

Nicholas Dorich, PharmD is the Associate Director, Pharmacy Accounts for Pharmacy Quality Solutions. His team works directly with pharmacy organizations representing more than 60,000 pharmacies in the United States. Nicholas’ passion in the pharmacy profession includes expanding clinical services for pharmacists and recognition for pharmacists as an integrated member of the patient care team.