Revenue Management

partdImprove your Part D Star Measures & More

Don’t wait until it is too late to impact your Part D STAR ratings.

PrescienceRxTM monitors compliance/adherence monthly so you have the information you need at the member level to improve performance. PrescienceRx includes action alerts to help you prioritize patients and target interventions for these measures:

Measure: D09 – High Risk Medication

  • Plan Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, When There May Be Safer Drug Choices

Measure: D10 – Diabetes Treatment

  • Using the Kind of Blood Pressure Medication That Is Recommended for People with Diabetes

Measure: D11 – Medication Adherence for Diabetes Medications

  • Taking Diabetes Medication as Directed

Measure: D12 – Medication Adherence for Hypertension (RAS antagonists)

  • Taking Blood Pressure Medication as Directed

Measure: D13 – Medication Adherence for Cholesterol (Statins)

  • Taking Cholesterol Medication as Directed

What PrescienceRx Does…

  • Generate rates throughout the year and estimate Star rating to gain a sense of progress and identify the need for more aggressive actions.
  • Identify providers who are not managing patients with respect to Rx adherence.
  • Provide practitioners with list of noncompliant patients.

We also recognize the importance of pharmacy management beyond the CMS measures

PrescienceRx provides you with ancillary information in near real time supporting a range of care management activities including:

  • Alerts by member/condition/drug if any potential adherence issues exist for any drug you want to monitor.
  • Alerts for CMS “High Risk Drugs” (Beers Criteria).
  • Identification of members for Medication Therapy Management.
  • Identification of members for potential controlled substance abuse, ranking potential as high, medium or low.
  • Ranking of members by predicted risk for Total Medical Expense.
  • Ranking of members by Coordination Risk – the challenges to patient management.
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