In 2025, Medicare Advantage plans can't afford to rely on outdated medication adherence strategies. With CMS's latest announcement revealing only 40% of MA plans will achieve four-star ratings or higher, the message is clear: traditional approaches to medication adherence are no longer sufficient.
The key takeaway is clear. As member experience measures decrease in weight, medication adherence metrics for diabetes, hypertension, and cholesterol are becoming even more critical to STAR ratings success. Plans that fail to modernize their adherence programs with sophisticated technology and data-driven engagement strategies risk falling behind in an increasingly competitive landscape. The time for transformation is now – and it starts with reimagining how we tackle medication adherence.
Shifting Measurement Weightings Create New Opportunities
While recent headlines have focused on lawsuits regarding STAR ratings methodology, the path forward requires a clear focus on what matters most: medication adherence. As member experience measures transition from a 4X to 2X weight, medication adherence measures for diabetes, hypertension, and cholesterol maintain their 3.0 weight - making them increasingly crucial to overall performance.
Understanding the Impact on Quality Bonus Payments
This re-weighting means medication adherence will drive a higher percentage of raw STAR scores, creating both risks and opportunities:
- Poor medication adherence performance will have an amplified negative impact on overall ratings
- Strong adherence metrics could significantly boost STAR ratings under the revised weighting system
- Quality bonus payments and rebates will be increasingly tied to medication adherence success
Strategic Imperatives for 2025
Health plans must evolve their approach to medication adherence beyond traditional methods. Unlike one-time compliance measures, medication adherence requires sophisticated, ongoing monitoring to ensure proper prescription refill timing.
Success in 2025 demands:
Moving Beyond the Call Center
To achieve meaningful improvement, plans must transition from manual, labor-intensive processes to sophisticated member engagement strategies. This transformation enables pharmacists and member advocates to engage more effectively with a larger member population while maintaining high-quality care standards.
The key to success lies in deploying strategic solutions that combine technology, data analytics, and targeted member outreach to drive sustained medication adherence improvement. As we move into 2025, plans that prioritize these initiatives will be best positioned to maintain or improve their STAR ratings in an increasingly challenging environment.
Start Strong in 2025
January presents the perfect opportunity to implement new strategies that will impact your 2025 STAR ratings. Don't wait until mid-year to address medication adherence challenges. By partnering with the right technology-enabled services now, you can begin generating measurable improvements in member adherence from day one.
Ready to transform your medication adherence program and boost your STAR ratings? Contact our experts to schedule a consultation and learn how our proven approach can help you achieve your 2025 STAR rating goals.