Contributors

Dr. Matt Weyenberg
Chief Medical Officer, CSHN

Tyler Wilson
Executive Director of
Medicare Programs, CSHN

Over the last 6 years, Catalyst Senior Health Network has engaged with Stellus Rx to deploy Stellus Adhere as a fundamental component of the Network’s overall performance strategy. Network members trust Stellus Rx as a partner in identifying and closing medication adherence gaps among 30,000+ lives in the network’s Medicare Advantage patient population.

Results from the multi-year, multi-market engagement point to scalable and enduring success:

• Three straight years of 5-Star (or better) performance in the three triple-weighted medication adherence measures with the Network’s largest payer contract
• 6-Star performance with this payer in 2022—the first time a group of Catalyst’s size had achieved that feat
• Referenced as the highest-performing group in North Texas by multiple payers

Most importantly, patients gain extra support to propel them toward better health.But what has driven the successful collaboration between Catalyst Senior Health Network and Stellus Rx, and what might that indicate about the future of healthcare delivery as a team sport in value-based models?

Catalyst Senior Health Network executives Dr. Matt Weyenberg (Chief Medical Officer) and Tyler Wilson (Executive Director, Medicare Programs) share their insights.

Set the stage for us. What can you share about Catalyst Senior Health Network and your physician members?

Tyler: Stats paint a part of the picture for what Catalyst Senior Health Network encompasses: 350+ providers … 30+ different tax IDs … three different geographic regions. These physicians and their offices provide care to tens of thousands of Medicare Advantage patients, and they’re all connected through a network model with a significant amount of variance in locations, in demographics served, in preferences and beliefs for how care should be delivered.

So what you see there is a pretty diverse group of providers with massive influence on the care and wellbeing of thousands of senior patients throughout Texas. But peel back the onion a couple layers and you start to see that for all the ways these physicians and practices are different, they also share a host of common principles and common challenges.

For one, they’re united in the belief that relationship-driven primary care remains essential to the long-term health of the patients they serve. They’re energized by primary care’s migration from fee-for-service to value-based care models—especially for patients who need more intense focus and support in their health journeys. And at the same time, figuring out how to do all that is a challenge in and of itself.

Matt: That’s right. In speaking with and working alongside our physician members over the years, I’ve seen that as members go deeper into value-based care, they gain greater understanding of the levers for success—whether it’s burden of illness, accurate diagnosis coding, quality, growth or clinical program enrollment—as well as greater appreciation for the complexities. And they’ve realized: I can’t do this alone. I don’t have the resources within my four walls to meet all the different requirements and deliver care I want to—and the way my patients deserve. So each of these physicians has looked beyond their practices to lean on the support of organizations like Catalyst and Stellus Rx.

What we’ve seen is that when physicians and their practices do this—when they lean into the centralized support from Catalyst and Stellus Rx and allow our organizations to extend the care provided by the physicians themselves—their practices thrive. Partners like Stellus Rx become force multipliers, allowing physicians to deliver care the way they’ve always wanted to, but may have felt limited from a time or resource perspective.

Among the physician groups you’ve worked with, how does the evolution happen for them to go from, “I need to do as much as I can myself to limit costs and control outcomes” … and instead change to, “I need to lean on external organizations for specific expertise”?

Matt: In general, I think most physicians are more open to receiving help in areas where, previously, they may not have been. Some of that is no doubt due to staffing concerns and the challenges that have amplified since COVID.

For example, hiring and retaining medical assistants and front office staff members has become increasingly difficult. So they feel that pressure in combination with the additional requirements that come along with performing in value-based care models. And as a result, we’ve heard many of our physicians talk about how organizations like Catalyst and Stellus Rx have moved from “nice to have” to “need to have” partners to help them truly operationalize these more intensive, comprehensive care delivery models without creating more physician and staff burnout.

Tyler: Just adding a bit more color to that … for our physicians who are taking care of large populations of Medicare Advantage patients, even the way they have to think about medicine and care delivery is changing. Care remains patient-focused at its core, but the additional and required attention paid to quality, documentation, clinical programs and growth means that—now more than ever—healthcare is a team sport that demands and increasingly larger and more expert team.

Physicians have this deserved reputation for being intelligent problem-solvers. But even more than that, they’re extremely results-minded. So while the natural instinct might be to try to do as much as possible on their own, it’s overridden by seeing the results and outcomes achieved by their peers and being open to doing what’s necessary to achieve similar results.

Turning specifically to Stellus Adhere, then, and the value created for Catalyst Senior Health Network members … how would you describe the experience that Catalyst physicians have had with the solution?

Tyler: Our physician members describe Stellus Adhere as a force multiplier of their clinical effort and impact. And it makes sense that they would think of it that way. If you’re a physician caring for MA patients, part of your performance is measured on how adherent your patients are to their prescribed medications. But that’s a significant portion of the patient experience that physicians often have the least control over. So you end up with patients who need medication refills that … one, you don’t know about … and two, you and your staff wouldn’t have had time to review complex data across multiple MA payers to know that the gap existed or to intervene on behalf of the patient for that refill.

But with Stellus Adhere, all that just happens—mostly in the background—with Stellus Rx identifying the gaps and proactively reaching out to patients to ensure they get their necessary refills. You can see why that would be meaningful for patients and physicians.

Last night, we had a meeting with a board of our physician members, where we reviewed year-over-year trends of our performance—and a huge component of those successes is determined by CMS Star ratings. Our physicians say and understand this: Our Star ratings stand on the shoulders of what Stellus Rx accomplishes for us. Three of the five adherence measures are triple-weighted, so that has a massively disproportionate impact on our quality for the plan and on things like share of surplus and the ability to get the maximum financial opportunity that our members earn from payers.

Matt: One thing I’d add to that is that when we talk to our colleagues at our largest payer, they have confirmed for us that what Stellus Adhere does for our network performance model is simply unprecedented. The types of scores that Catalyst’s network of physicians have been putting on the scoreboard, so to speak, wouldn’t be possible without Stellus Adhere. And it’s important to note that these adherence scores truly represent patients taking their medications more consistently—which, in turn, creates clinical improvement, while also reducing their overall utilization of healthcare services.

How much of this would you chalk up to simply focusing on solving the right problem vs. deploying a uniquely valuable solution in the space?

Tyler: It’s an interesting question. We’re certainly not the first physician network to realize that medication adherence is a problem. It’s a big piece of our quality score … we know we should give it focus. We’re not the first ones to try to find someone to call patients. Tons of people have thought of that … but as far as I know, no one has figured out how to improve adherence with such consistent results across different geographies, like Stellus Rx has.

We had five Stars across the board last year, in all geographies that Catalyst serves. And that’s in a network model that has inherent variance from practice to practice. It’d be remarkable if Stellus Rx pulled that off just in North Texas with a single EMR and model of care. But doing it with such predictable success in a network model, across multiple geographic markets means that Stellus Rx has figured out something that others just have not been able to do.

I think part of the secret sauce, if you will, is that Stellus Adhere is incorporated within our physicians’ daily workflows. That’s not lost on our members. Stellus Rx pharmacists are communicating directly with our physician members in their EMRs to let them know when gaps are closed and when challenges arise. It creates a seamless experience that’s more of a natural extension of the practice than I’ve seen from any other solution provider.