Clinical Support Services (CSS) has developed a Star Ratings Booster™ Assessment module within its Medication Pathfinder™ platform to assist Medicare Advantage Prescription Drug Plan (MA-PDP) and Prescription Drug Plan (PDP) organizations support and enhance their quality performance ratings under increased scrutiny by CMS.

Extending beyond a consultative role, CSS has developed the technology and clinical expertise to assist Medicare plans bolster select Part D (Prescription Drug Event) and Part C (HEDIS™-based) measures.

Measures included under Part C domains:

• Staying Healthy
  • The percentage of members who have had a colorectal screening in the past year
  • Cholesterol Management for Patients with Cardiovascular Disease Conditions
  • The percentage of members with diabetes who have had cholesterol screening in the last year
  • The percentage of members who have had an annual osteoporosis test (BMD) in the past year
  • The percentage of members who have had an annual flu vaccine (prior to flu season)
  • The percentage of members who have had an annual Pneumonia vaccine
  • Annual Monitoring for Patients on Persistent Medications – Digoxin
  • Annual Monitoring for Patients on Persistent Medications – Diuretics
  • Annual Monitoring for Patients on Persistent Medications – Anticonvulsants
  • Annual Monitoring for Patients on Persistent Medications – ACE/ARB
• Managing Chronic Conditions
  • Osteoporosis Management in Women who had a fracture
  • Eye exam to check for damage from diabetes – DRE last 12 months
  • Kidney disease monitoring for members with diabetes – presence of Kidney Function Tests or on ACE/ARB medication therapy
  • Percentage of plan members with diabetes whose blood sugar is under control- HbA1c > 9%.  Also included is a recommendation when no A1c value is present in patient's chart
  • Percentage of plan members with diabetes whose cholesterol is under control- LDL-C > 100mg/dl
  • Controlling blood pressure – BP > 135/80 & BP>140/90
  • Controlling High Blood Pressure
  • Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis

 Measures included under Part D domains:

• Drug Pricing and Patient Safety
  • Drug plan members 65 and older who received prescriptions for certain drugs with a high risk of side effects, when safer drug choices may be possible – HRM
  • Using the appropriate blood pressure medication recommended for people with diabetes – DTM (use of ACE/ARB) vs. other HTN therapies (complete list of medications available)
  • Medication Adherence:  five individual medication measures calculating MPR for the CMS identified medications
  • Diabetes Maximum Daily Dose measure

CSS's web-based module enables pharmacy and medical claims data to be uploaded to the client's patient profiles, along with any other clinical data (i.e. lab values) available to the MA-PDP/PDP.  Using the claims data – and any clinical source information available – the module allows CSS clinicians to identify certain non-compliant Part C and D measures that would negatively impact a client's Star Rating.

Once a measure has been tagged as non-compliant, CSS proactively reaches out to the respective patient and his/her physician to bring the measure into compliance. This proactive feature gives CSS the potential to improve a client's Star Ratings measure over time -- one of the biggest challenges facing plan sponsors today.

CSS will work directly with clients around their data specifications, extraction, translation, and loading routines.  The web-based Star Ratings Booster Assessment module has an unlimited capacity related to number of patients that can be entered in the module.

The Medication Pathfinder Star Ratings Booster is built in accordance with the latest HEDIS-based guidelines.