3 Organizations Target Nonadherence, Boost CMS Scores with Medication History

Medication History for Populations helps make interoperability an everyday reality. Just ask these three healthcare organizations, who use the data for at-a-glance medication adherence scores and targeted patient outreach.

1. Parkland Health boosts outcomes for high-risk patients

Dallas-based Parkland Health serves more than one million patients a year at dozens of locations, including an acute-care hospital with a Level I trauma center and 20 community-based clinics.

• Problem: One million patients per year made it difficult for population health teams at Parkland Health to pinpoint nonadherence, making timely interventions more difficult.
• Solution: One program using Surescripts Medication History for Populations data helped cut the need for 90-day follow-up calls by approximately 20%. And in another program for high-risk patients, Parkland Health streamlined medication reconciliation, avoided adverse drug events and reduced 30-day readmissions by 27%.

“Many patients come to Parkland,” said Esther Thomas, Pharm.D., of Parkland Health. “They may not have insurance, but they may still be filling prescriptions. [Medication History] helps the providers see what they’ve been on or where they’ve been last and where they picked up medications.”

2. Aledade boosts its CMS quality scores

Based in Bethesda, Maryland, Aledade is a network of physician-led accountable care organizations (ACOs) that serves 840,000 patients across hundreds of medical practices and 27 states.

• Problem: The metrics on medication adherence for patients with diabetes, cholesterol and hypertension account for up to 30% of Aledade’s rating under the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System. But many patients with these chronic conditions struggle with adherence—and relying on payer claims data made it tough for Aledade to know which patients to prioritize for outreach.
• Solution: Medication History for Populations enabled Aledade to achieve 4, 4, and 5 stars for adherence metrics on patients with diabetes, cholesterol and hypertension. Plus, Aledade eliminated 585 unnecessary patient interventions—a 26% reduction in false positives for medication nonadherence. This allowed providers to focus on validated, more targeted outreach.

“We were 100% reliant on payer claims data,” said Megan Slaga, Pharm.D., Senior Director of Pharmacy at Aledade. “Our first thought was Surescripts as a potential option to help close that gap.”

3. Mount Sinai boosts adherence for patients with heart failure

Mount Sinai in New York City covers three boroughs with 13 hospitals and thousands of physicians across more than 400 community locations.

• Problem: Patients with heart failure often need intervention. And the care team must act sooner, not later. But claims data lags (and doesn’t include patients who pay with cash). This means the care team won’t necessarily have the insight it needs to gauge the persistence of beta blockers in the patient for 60 days, as measured by CMS.
• Solution: After just five months using Medication History for Populations, the Mount Sinai team was already seeing promising results. The percentage days calculated (PDC) rate, which indicates how long a patient has been adherent to medication, had gone up by nearly 60%.

“Surescripts notifications allow us to know the right time to contact patients and help facilitate their education and engagement with providers,” said Robert Dean, Care Navigator at Mount Sinai. “Every day we’re reviewing medication alerts. We’re checking our lists to see who’s the highest priority for outreach.”