How a CMS Star Rating Impacts Your Independent Pharmacy

Many factors determine your pharmacy’s success. It’s more than just how quickly you can fill a prescription. There’s the location of your pharmacy, the kind of pharmacy software system you use, how you interpret market research, and so much more.

Then there’s the Star Rating system by the Center for Medicare and Medicaid Services (CMS). Though not specifically tailored to the pharmacy industry, it wields a massive influence on your pharmacy’s success.

Here are the basics about the Star Rating system and how you can get to the top.

What is a Star Rating?

The Star Ratings system measures the performance and quality of Medicare plans.

According to PBA Health,

“CMS developed the Star Ratings system to help measure the quality of patient care that different health plans were providing.”

The Star Ratings system lets patients compare the quality of different health plans in an easy-to-understand way.

As the name suggests, the Star Ratings System rates Medicare plans on a one-to-five-star scale — one star meaning poor quality and a five-star one being the best of the best.

A health plan’s Star Rating is determined by five key factors:

  • Management of high-risk medications
  • Diabetes treatment
  • Medication adherence for diabetes
  • Adherence for hypertension
  • Adherence for Cholesterol

Medicare patients are able to figure out which plan is best for them through the Star Rating system. Tell your patients about the Medicare Plan Finder tool to further help them find the best plan possible.

How Does a Star Rating Affect Your Independent Pharmacy?

Patient adherence is one of the biggest determinants of a health plan’s star rating. As such, independent pharmacies have a huge responsibility in promoting patient adherence.

As an independent pharmacist, you’re face-to-face with your patients when dispensing their medications. It’s your job to help navigate them through their health journey. Promoting patient adherence should already be a large priority for your independent pharmacy. If patients take their medications as prescribed, they will shop at your pharmacy more regularly and increase its profitability.

If your independent pharmacy excels at the patient adherence front, it will become more attractive to “regional health plans that value patient care and outcomes.

Medicare measures patient adherence through the Proportion of Days Covered (PDC) methodology, which APRX defines as “what percentage of days does the patients have the medication.”

The Star Rating system places a heavy emphasis on maintenance medications, specifically ones used for diabetes, cholesterol, and hypertension.

Check out our “The Importance of Patient Adherence and How to Master It” blog for more information about adherence and how your pharmacy can better promote it.

It’s important to note that the Star Rating system only applies to health plans and not independent pharmacies. However, health plans can look at a pharmacy and see how well it promotes general health and patient adherence.

Health plans will rework their network to consist of highly-rated pharmacies. Hard work does indeed pay off in the long run.

Your independent pharmacy will be more attractive to the health plans that have a higher star rating if you have a high patient adherence rate.

As a result, your pharmacy will be bunched up among other exceptional healthcare facilities in that higher tier. That means a bigger network of patients and the chance to cultivate an even bigger customer base.

Greater profit also opens the door to exploring other revenue streams, namely more automated and clinical services. Think of it as a domino effect that makes your pharmacy to be more exceptional with the passage of time.

Though your pharmacy isn’t explicitly a participant in the Star Rating system, it still plays a vital role in shaping health plans around your community. Patients want only the best out of their healthcare. Ensure that your independent pharmacy is synonymous with a five-star rating.

How You Can Be a Big Fish in a Big Pond

Now that we know ins and outs of the Star Rating system, it’s time to learn how we can be more attractive to highly-rated health plans. Though patient adherence is the big one, there are other elements to your pharmacy work that will determine your place in the healthcare landscape.

1. Focus on the Patient

Even with all the fancy bells and whistles of the pharmacy industry, your top priority should always be the safety and well-being of your patients. As we all know, that goes beyond just filling a prescription.

The patient-pharmacist relationship is never an open and shut case. It’s an ongoing, ever-changing dynamic that hopefully improves alongside the patient’s health. A quality relationship with your patients requires you and your staff to offer personalized care that truly improves their health.

As we said in our “How to Boost Your Pharmacy’s Review Scores” blog, positive word of mouth will go a long way in driving your pharmacy’s profit. That doesn’t only apply to patient care.

Once your pharmacy gains a reputation of patient-based excellence, it’ll catch the eyes of highly-rated health plans. Health plans with a high star rating enjoy a bevy of benefits, including:

  • Eligibility for incentives
  • Qualifying for yearly bonuses
  • Ability to enroll patients year-round

Health plans with a higher star rating will have a more robust patient base that expects more from their healthcare service. They know quality work when they see it, so make sure you’re fulfilling your end of the bargain.

2. Have a Pharmacy Software System that Helps You Out

Much of a pharmacy’s star rating revolve around patient care. Delivering personalized healthcare services can be difficult on multiple fronts, so have a pharmacy software system that can help ease the load.

Your pharmacy software can do more than log prescription fills. A patient’s profile paints a comprehensive and easy-to-understand picture of their current health journey.

Your software should tell if patient adherence is being promoted and suggest ways to improve, such as day supply — patients tend to pick their prescriptions up more consistently when they don’t have to frequently go to the pharmacy.

Going from a 30 to a 90-day supply fill is a quick and painless adjustment that can have long-term benefits for both your pharmacy and patients.

Then there’s also medication synchronization. CMS Star Ratings focus on Medicare Part D patients, who are primarily older adults and people with long-term disabilities.

The bulk of these patients takes multiple maintenance medications — namely for blood pressure, diabetes, and cholesterol (the same medications CMS looks into for Star Ratings).

Your pharmacy’s patient adherence will flourish if you have software that has med sync capabilities. Med sync is a proven way to boost adherence, thus making you tailored to be in the five-star bracket.

How Will You Provide Five-Star Healthcare?

It’s all about the patients. Though Star Ratings don’t directly affect your pharmacy, your placement will shape your business’s long-term success. The Star Rating system awards pharmacies for their innovation and dedication to quality patient care.

You have all the right tools at your disposal: your pharmacy staff, your customer base, and a pharmacy software system that can help lighten the load. Now it’s a matter of execution, so earn the Star Rating you know you deserve.