How Aledade Improved its Star Ratings with Enhanced Medication History

Late last year, Aledade was seeking a way to help providers close care gaps and improve outcomes for patients at risk of medication non-adherence. Aledade’s scope of service is vast: representing 840,000 patients and more than 550 practices across 27 states.

 

Identifying opportunities to close gaps in care—and close them efficiently—is essential to its mission of delivering value-based care at lower cost. But because prescription claims data is often incomplete and can lag for months, it was hard for Aledade’s providers to identify and prioritize clinical interventions for patients at risk of non-adherence.

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

Aledade worked with Surescripts to pilot a program using Surescripts Medication History for Populations. The pilot focused on diabetes, cholesterol and hypertension non-adherence, which are three-triple weighted measures accounting for up to 30% of Aledade’s Star rating. Adherence is critical to maintaining the health of patients with these conditions.

With Surescripts, AledadeACOs could proactively access comprehensive dispensed medication history data directly from pharmacies via their analytics platform.

Powered by this information, the impact was astounding.

Aledade was able to eliminate 585 unnecessary patient interventions out of 2,235 opportunities identified from payer claims data—reducing false positives for medication non-adherence by 26%. And it achieved 4, 4, and 5 stars for diabetes, cholesterol and hypertension under the Centers for Medicare & Medicaid Services Five-Star Quality Rating System for Medicare Advantage contracts, resulting in pay-for-performance bonuses.

For the full story, check out this case study as well as our recent LinkedIn Live conversation.