What we’ve heard …
Why would I need outside help to elevate the medication-related performance measures in my MA contracts? Couldn’t I just hire my own pharmacists and pharmacy technicians for less operating expense?
Access to timely data
Our clients tell us that with some contracts, they never felt like they had a fighting chance.
Paul Flemming, Director of Quality Improvement at Palmetto Primary Care in South Carolina, says it well: “A major challenge was that the data we received from health plans was delayed and often outdated. Even when we attempted to work the payer lists, we found that either the patient had already picked up the medication by the time we called them … or the patient had already failed the measure.”
Stellus Rx attacks this challenge by:
- Leveraging strong relationships with payers/PBMs to access more recently updated data and with greater frequency
- Automating data gathering from payer portals and immediately ingesting the data into our application for analysis and prioritization of clinical interactions
Systems that aren’t optimized for productivity
Most regularly, provider groups work through list of patients on Excel sheets. And whether it’s a “hunt and peck” approach of scrolling through data to find patients with potential adherence gaps … or using native tools in Excel to accelerate the process, in-house teams are often left bewildered by the time required compared to the value produced.
Again from Palmetto’s Paul Fleming: “Our team simply could not devote the time needed to manage hundreds of patients from multiple insurance plan contracts to move the needle on medication adherence Star scores. That literally would have been our full-time jobs.”
At Stellus Rx:
- Our work is underpinned by a purpose-built system, with automated data ingestion of payer data across multiple formats
- The business rules engine identifies and prioritizes adherence gaps that need attention
- Data-driven workflows enable pharmacist-led outreach
Processes built for output, not outcomes
Throughout the industry, primary care providers aren’t afforded the time and bandwidth to dedicate enough focus on adherence (more on that below). As a result—and with the best of intentions—gap closure often resembles friendly reminder calls and message.
Shannon Smith, Chief Operating Officer for Community Health Care in Ohio, describes: “We would reach out to patients, but we’re not pharmacists, so that wasn’t well received from patients. They were missing that expert voice who could walk them through why these medications are so important.”
Compare that to Stellus Rx’s approach to driving adherence performance. Pharmacists provide expert clinical review of patients prioritized by our application and …
- Conduct pharmacy outreach if refill exists or provider outreach when new prescriptions are needed
- Provide personal outreach to patients with a ”listen, learn, solve together” approach until gap closure
- Collaborate with providers address time-sensitive issues and inform next steps
From Dr. Amanda Williams, Medical Director at Physicians Group of Southeastern Ohio: “Stellus Rx is coming in and doing behind-the-scenes work that otherwise, we would not have had the bandwidth for.”
Prioritization, expertise and focus
Even in provider groups with pharmacists on-staff, clinical priorities and initiatives span a wide spectrum: treatment protocol development, therapy changes and recommendations, patient education, quality assurance … the list goes on.
Adherence moves to the backburner because it can be tedious and often maddening. “It was very frustrating for us and was in some ways, a waste of valuable time,” says Palmetto’s Paul Fleming. “We turned our focus toward measures where we could move the needle, such as colorectal and breast cancer screenings.”
The Stellus Rx approach:
- Clinical pharmacists and pharmacy technicians dedicate full focus to solving adherence challenges for clients
- Teams serve as virtual extensions of client teams and operate in their workflows and EMRs
- Clients no longer need to train new staff on adherence gap closure or worry about unexpected staff departures; clients can also add new lives/payer contracts in a rapidly scalable way
- Client pharmacists are enabled to focus on other clinical initiatives
From Brittany Orr, Vice President of Quality for Millennium Physician Group: “It feels like Stellus Rx is part of our team. More than making phone calls for us, they’re helping us perform better on our contracts.”
Alignment of incentives
Other than individual performance reviews that could include Star ratings as a component, no formal structures exist for staff pharmacists and in-house quality teams to connect Star performance to financial outcomes.
Stellus Rx includes financial upside and downside components as performance guarantees in standard client contracts.
These components ensure mutually aligned incentives for success across all medication-related measures.