How Aledade improved quality scores and star ratings with medication history

Aledade is the largest physician-led network of accountable care organizations (ACOs) in the U.S. Launched in 2014, Aledade partners with 550 independent medical practices across 27 states, totaling $7.5 billion in healthcare spending. With 840,000 patients under care of 7,300 providers, Aledade sought a way to help its providers close care gaps and improve outcomes for patients at risk of medication non-adherence.

But incomplete prescription claims data and a delivery lag of weeks or months make it difficult to spot gaps in care and identify legitimate opportunities for patient outreach. How can providers accurately determine patients at risk of medication non-adherence? And, how can they prioritize worthwhile outreach to improve outcomes?

Identifying opportunities to close gaps in care—and close those gaps efficiently—is essential to Aledade’s mission of delivering value-based care at lower cost. “This is a huge opportunity for us to help providers and clinical staff understand when patients are struggling with medication adherence,” said Megan Slaga, Pharm.D., director of pharmacy at Aledade.

To pilot-test a program that would help providers to identify and follow up with patients at risk of medication non-adherence, Aledade focused on diabetes, high cholesterol and hypertension. These conditions represent 30% of Aledade’s Star rating, based on three triple-weighted measures for medication adherence. Adherence is crucial to maintaining health for patients with these conditions. And timely and accurate data enables providers to efficiently prioritize patient outreach and improve outcomes.

Aledade and Surescripts entered a process of data integration that ran on a weekly cadence in November and December of 2019. Aledade and its three-person pilot team sent its payer claims data to Surescripts. In turn, Surescripts used comprehensive dispensed medication history from pharmacies to clean, validate and supplement the payer claims data. “Surescripts had a very nice 24-hour turnaround,” Slaga said.

Surescripts Medication History for Populations improved outcomes on multiple fronts, including:

1. Validated, trusted data delivered to providers led to increased engagement between Aledade and the medical practices in its network.
2. Smaller, more targeted outreach lists eliminated hundreds of unnecessary patient interventions for providers and staff, reducing daily workload and administrative burden.
3. Accurate and timely data enabled early identification of patients who were struggling with medication adherence and to close gaps in care.
4. Actionable intelligence enabled Aledade to achieve 4, 4, and 5 stars for diabetes, cholesterol and hypertension under the CMS Five-Star Quality Rating System, based on medication adherence metrics.

Manual payer claims data

• Lag in payer claims data of 2–3 months, resulting in data that was not representative of patients’ true medication adherence status
• A list of 2,235 patient outreach opportunities that included patients who may have already picked up their prescribed medications or who may have become adherent in the past 2–3 months

Automated medication history data

• 24-hour turnaround on delivery of clean, up-to-date medication history data from pharmacies on virtually every patient, for every drug
• Eliminated 585 unnecessary patient interventions (a 26% reduction in false positives for medication non-adherence), allowing providers to focus on a smaller group of patients with validated outreach opportunities and increased efficiency

Manual payer claims data

• “Patients were no longer eligible or had already failed the adherence metric.”
• “We hear from providers about alert fatigue.”
• “Medication adherence initiatives are good for patients but aren’t being prioritized because of the data lag.”

Automated medication history data

• “It’s hugely valuable to help patients remain adherent to these crucial medications.”
• “Providers conduct more effective outreach because they can focus resources on a smaller group of patients.”
• “We had higher engagement rates with our providers to do this work.”

Limit focus for proof of concept.

Aledade focused on three common disease states—diabetes, cholesterol and hypertension—to improve the quality of patient outreach opportunities for providers and medication adherence metrics.

Budget for manual data integration.

The goal is to fully automate the process, but the initial pilot required an upfront investment of time and resources. For the pilot, Aledade employed a three-person team. One pharmacist on the team used 20% of her time on manual data integration, although this time will be eliminated once automation is achieved.

Take advantage of Surescripts resources.

Surescripts offers documentation, training materials and best practices to its customers. Aledade leveraged this during implementation and continues to gather input from developers and end users as it looks toward expanding into additional markets for broader testing and evaluation.

“I always knew I wanted to be a pharmacist,” Slaga said, “and I grew up at a time when healthcare was becoming incredibly tech enabled. I really wanted to help change the pharmacy industry and move us into the future.” This ultimately led to her current role as director of pharmacy at Aledade. Today, Slaga sees tremendous promise in using data to fulfill Aledade’s mission to deliver value-based care at lower cost.

“That’s why we’re moving forward with Surescripts,” she said. “Even if providers gained just 10 minutes a day with the added efficiency, they can prioritize the right patients with those 10 minutes.” To illustrate her point, Slaga shared the example of the first Aledade-Surescripts partnership, which involved pinpointing cash-pay transactions for statins that were not reflected in payer claim data. This reduced the number of unnecessary patient interventions for providers and increased the quality of Aledade’s statin use measures.

And Slaga sees applications beyond diabetes, cholesterol and hypertension, such as for anticoagulants, which patients must take every day to reduce their risk of heart attack and stroke. In these and other cases, actionable intelligence at providers’ fingertips is crucial.

Based on the pilot program’s success, Aledade plans to expand the delivery of dispensed medication history from pharmacies into two additional markets for broader testing and evaluation. After that, Slaga anticipates scaling to all 550 medical practices and 7,300 primary care providers. “And then,” she said, “all of our patients will benefit.”