Helping Plan Sponsors Achieve High Quality Ratings

How Tailored Programs Can Help Close Gaps in Care, Improve Adherence

November 18, 2019
Former Vice President of Enterprise Health Plans and Market Strategy, CVS Health

Partnering with CVS Health to improve adherence, education, and gaps in care can enable health plans to improve outcomes and metrics for the recently released Centers for Medicare & Medicaid Services Five-Star Quality Ratings and Healthcare Effectiveness Data and Information Set (HEDIS).

The challenge with Medicare beneficiaries, as health plans know, is to effectively address the barriers to care many of them encounter: complex drug regimens, fixed incomes, drug side effects, communication difficulties, low health literacy, and transportation or mobility issues. Plan sponsors need support on key measures, such as prescription adherence, to reach their goals.

We have a broad suite of capabilities to help affect outcomes based on experience with 3.8 million lives in Medicare Advantage Part D plans supported by CVS Health, of which 3.1 million beneficiaries are in contracts with a four star or higher Part D rating.CVS Health October 2019 for 2020 Star ratings. P1003101119. To help health plans achieve high performance metrics, our tailored services and programs cover a wide range of needs and offer beneficiaries convenient, high quality care and the support they need, when they need it — on the phone, online, or in-person at a CVS Pharmacy location. CVS Health engages with customers through its 9,900 pharmacies, 1,100 MinuteClinic locations and the growing number of HealthHUB locations, set to reach 1,500 sites across the U.S. by the end of 2021. An estimated 5 million customers visit CVS Pharmacy locations every day.;

Convenience Drives Improvement

In addition to more than 9,900 CVS Pharmacy locations where beneficiaries can pick up prescriptions and talk to a pharmacist, we also offer services that promote adherence by providing more convenience.


ReadyFill, our automatic prescription refill and renewal program, can help improve monthly prescription refill rates by up to 3 percentage points.Olga S. Matlin, PhD; Steven M. Kymes, PhD; Alice Averbukh, MBA, MS; Niteesh K. Choudhry, MD, PhD; Troyen A. Brennan, MD, MPH; Andrew Bunton, MBA, CFA; Timothy A. Ducharme, MBA; Peter D. Simmons, RPh; and William H. Shrank, MD, MSHS. Community Pharmacy Automatic Refill Program Improves Adherence to Maintenance Therapy and Reduces Wasted Medication. Am J Manag Care. 2015;21(11):785-791.


Beneficiaries have the option of filling 90-day prescriptions through our mail order or retail pharmacy and either picking them up or having them delivered to their home, office, or location of their choosing. Our prescription delivery service has been shown to help increase optimal adherence by up to 11 percent.“The Adherence Impact of a Program Offering Specialty Pharmacy Services to Patients Using Retail Pharmacies,”Journal of the American Pharmacists Association 56 (2016) 47-53 In press.


ScriptSync sets beneficiaries’ prescriptions for pick up for the same day each month to eliminate the need for multiple trips to the pharmacy. ScriptScync can help improve adherence by up to 10.6 percent.CVS Health: The impact of a retail prescription synchronization program on medication adherence, Journal of the American Pharmacists Association (2017), doi:10.1016/j.japj.2017.05.016.


Our multi-dose packaging combines multiple medications into a single pill pack labeled for use at the correct time of day. The service has been shown to enhance therapy management and can improve adherence by as much as 8.6 percent.Enterprise Evaluation and Population Health Analytics; MDP evaluation, December 2016.


The ScriptPath prescription schedule provides a consolidated view of a beneficiary's current CVS Pharmacy prescriptions conveniently grouped into a recommended dosing schedule. ScriptPath can help improve adherence by up to 11 percent.CVS Health Enterprise Analytics, 2017.

High-Touch Service for Complex, Chronic Conditions

Digital tools are an important way we engage with patients to help them stay adherent and ensure they receive an excellent customer experience. More than 77 million patients are enrolled in our text messaging program.CVS Health Internal Data, July 2019. P1002981019. These tools enable patients to order refills, check order history, view cost and savings, save a place in line at MinuteClinic and pose questions to a clinician. Enrollees can elect to receive real-time reminders to pick up refills and take medications on time.

And for members with complex, chronic or rare conditions, Accordant offers tailored support by specialized nurses to help them better understand their condition. Nurses also help members manage symptoms so they can stay adherent, prevent adverse events, and avoid unnecessary downstream costs, such as hospitalizations and visits to the emergency department (ED).

Using predictive modeling of patient data enables us to identify members who may need additional support, may be at risk of falling off therapy, or having a prescription rejected at the pharmacy. We tailor our approach to each individuals’ needs so they can stay adherent to their regimen.

Personalized Approach to Adherence

Increase of 3.86% of optimally adherent members with Pharmacy Advisor, according to a CVS Health Internal Analysis from 2018.CVS Health also offers a robust suite of services ranging from easy-to-understand medication regimen schedules to high-touch specialty care for complex, chronic conditions.

Pharmacist counseling through Pharmacy Advisor is aimed at improving care and provides opportunities for face-to-face interactions and targeted support. On first fill of a medication, counseling can help improve adherence and education, which can impact Star ratings on triple-weighted adherence measures. One-on-one pharmacist counseling is associated with a 3.86 percent improvement in optimally adherent members across all measurable conditions.CVS Health Internal Analysis, 2018.

Research indicates that the single largest reason Medicare Advantage patients fail to take their medicines is because they forget to do so. ScriptPath prescription schedule offers an easy-to-read and clinically effective schedule of when to take each medication in a regimen and can help improve adherence by nearly 11 percent.CVS Health: The impact of a retail prescription synchronization program on medication adherence, Journal of the American Pharmacists Association (2017), doi:10.1016/j.japj.2017.05.016. Adherence results may vary based on factors such as programs adopted by the plan. Client-specific modeling available upon request. Actual results may vary by client. Program is subject to state law restrictions.

HealthTag, available at CVS Pharmacy locations, provides enrolled patients with a reminder from a pharmacist to take action, such as getting recommended screenings or vaccinations. Printed reminders on the prescription pick-up bag also reinforce the message. One large health plan that used HealthTag messaging to alert a targeted set of recipients about the availability of a no-cost flu vaccination saw a 34 percent increase in flu vaccinations among those who received the messages compared to those who didn’t receive any messaging.CVS Health Enterprise Analytics, 2015.

Addressing Special Populations

Health plans that seek improvements in specific populations, measures, conditions, and/or outcomes can work with us to identify metrics and use our tailored programs for such groups. We can apply various programs to target those specific metrics, including diabetes, asthma, and vaccinations. Our clients had the highest average Star rating for statin use among beneficiaries with diabetes in the 2020 ratings period.CVS Health Analytics, October 2019. Calculated using Part D Star ratings for contracts under management by large pharmacy benefit management companies. CVS Health clients performed below industry average on three of 13 adherence metrics. P1003011019. The measure encourages plans to support beneficiaries with diabetes who should also lower their risk of developing heart disease by filling a statin prescription.

In addition to helping beneficiaries adhere to their medication regimens, we can support them in a wide range of health services that also affect HEDIS and Medicare Part C Star measures. MinuteClinic and HealthHUB locations can help close potential gaps in care including for those with chronic conditions, by providing access to a range of health and wellness services, such as screenings, tests and exams, and convenient care for minor illnesses. This helps ensure beneficiaries have access to medical care if they lack a primary care physician and helps them self-manage their conditions to avoid ED visits and hospitalizations. An average ED visit costs about $1,400 compared with about $100 for a MinuteClinic visit. MinuteClinic and HealthHUB locations can offer convenient, high-quality, cost-effective care.

For diabetes, hypertension and high cholesterol, adherence among beneficiaries in plans supported by CVS Health was more than 2.5 percentage points higher than industry averages.EQuIPP data, June 2019.
For diabetes, hypertension and high cholesterol, adherence among beneficiaries in plans supported by CVS Health was more than 2.5 percentage points higher than industry averages.18

For Medicare Advantage plans, boosting an overall Star rating to four stars from 3.5 stars provides access to 5 percent Quality Bonus Payments and up to 10 percent in double bonus counties. In addition, an MA-PD plan moving to four from three stars can generate 134 percent more value through additional program rebates, allowing the plan to provide improved benefits and lower premiums. Improvement to a four-star from a three-star rating can also increase revenue between 13.4 percent and 17.5 percent. That translates into $12 million to $16.2 million in revenue for a plan with 9,600 beneficiaries.

Keeping You and Your Providers Informed

CVS Health works to close gaps in information sharing with providers. We connect to a wide array of electronic health records to give health plans, physicians and pharmacists two-way sharing functionality that assists providers in guiding beneficiaries to stay on course with their treatment. Further, providers who are clinically affiliated with us can receive weekly reports to alert them when patients don’t pick up their prescriptions.

Health plans also have the option of receiving timely reports on how beneficiary populations are performing on key Medicare Star ratings and HEDIS measures. Reporting helps clients manage their quality efforts and discern their progress, while allowing our teams to consult on the appropriate engagement solutions to support quality measure improvement. Sharing measurements is one of the services we offer that complement a plan’s own data collection.

Want to know more about how our Medicare solutions can help improve your plan's Star rating? Ask Us
November 18, 2019
Former Vice President of Enterprise Health Plans and Market Strategy, CVS Health

The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted.

ReadyFill is a voluntary, automated prescription refill program for maintenance medications. The availability of ReadyFill to Medicaid beneficiaries is subject to state/territory regulations. ScriptSync requires enrollment of prescriptions in ReadyFill. Delivery may not be available at every address or from all CVS Pharmacy, CVS Pharmacy in Target and CarePlus CVS Pharmacy locations. Delivery fees apply.

Multi-dose packaging has been shown to improve adherence when continuously enrolled in this program. Covers a 30-day supply. Additional charges may apply for larger quantities.

Adherence results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request.

Conditions included in Pharmacy Advisor are: diabetes, hypertension, hyperlipidemia, congestive heart failure, coronary artery disease, depression, respiratory illness, osteoporosis, breast cancer.

Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan.

Accordant Health Services, LLC, a CVS Caremark company. All rights reserved. Accordant is a wholly owned subsidiary of CVS Caremark. Additional financial information is available upon request. Our program, care team and care manager do not provide diagnostic services or direct treatment or care. We assist patients in getting the care they need and our program is not a substitute for the medical diagnosis, treatment and/or instructions provided by health care providers.

Image source: Licensed from Getty Images, 2019.

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