Integrated Multistep Patient-Centered Program to Improve HEDIS Medication Adherence and Medicare Star Rating

Medication adherence (MA) has been a problem in healthcare for years. The MA for the purpose of this paper and project MA is defined as Proportion of Days Covered (PDC) of ≥ 80 % when patients fill their prescriptions on time as ordered by their Primary Healthcare Provider (PCP). There are devasting effects of medication nonadherence, which causes preventable deaths, hospital admission, injuries, and rising healthcare costs. Therefore, MA on certain maintenance medications for blood pressure, diabetes and cholesterol are included as a patient care quality measure in the Healthcare Effectiveness Data and Information Set (HEDIS) by the Centers for Medicare and Medicaid Services (CMS) among Medicare Advantage beneficences. PCPs are accountable and responsible for their patients for adherence with those medications. Providers or practices that achieve target scores in HEDIS on MA financially rewarded with bonuses from the health plans that bring extra revenue.
This doctoral project and paper intended to help providers and patients to address MA by implementing the Integrated Multistep Patient-Centered Program (IMPCP) in primary care to find out the effects on HEDIS scores and Medicare Star Rating (MSR). IMPCP was developed to address MA in the local primary care Managed Service Organizations (MSO) in South Florida. This design of this project was quasi - experimental with secondary analysis. Descriptive statistics were used as a method to manage data. In conclusion, the IMPCP improved HEDIS and MSR scores in the local MSO. This paper includes the description IMPCP, results, evaluation, critique, and plan for dissemination.