MEDICARE STAR CLINICAL PROGRAMS |

The impact of the SUPD program was substantially realized in 2022, the first full program year. THP’s Medicare performance improved 4-5%, and 1- and 2-Star increases were achieved based on currently available cut points. Despite continually rising benchmarks, the Medicare contracts are now at 3- and 4-Star performance based on 2022 performance and current cut points, and early 2023 data project a 5-Star finish for both contracts in the second full program year.

risk for members by adhering to guideline-, evidence-based recommendations for moderate or high intensity statin.

Underlining this initiative was an understanding of the immediate and long-term benefits to members and to THP as an organization. This partnership with MRx has proven successful in the first program year with >10% improvements in treatment rates, which equates to a 3-Star improvement in one year. Both Medicare contracts realized 5-Star performance based on currently available thresholds in the first program year, ensuring that over 89% of THP members with CVD at-risk realized the benefits of statin therapy. Based on 2021 performance data, THP has moved from the bottom 10th percentile nationally into the top 10th percentile in just one program year. Early 2023 projections are set to exceed 2022 performance with the maintenance of 5-Star performance.

^Program start date 10/29/2021

Note: 2020 Star performance is based on CMS 2022 Star Technical Notes. 2021 and 2022 Star performance is based on current thresholds listed in CMS 2023 Star Technical Notes. 2023 projections are based on year-over-year improvement with Acumen data through April.

^Program start date 10/29/2021

Note: 2020 Star performance based on CMS 2022 Star Technical Notes. 2021 and 2022 Star performance is based on current thresholds listed in CMS 2023 Star Technical Notes. 2023 projections are based on year-over-year improvement with Acumen data through April.

Statin Therapy for Patients with Cardiovascular Disease (SPC)

Following the implementation and early success of the SUPD program, THP and MRx expanded the business partnership, adding a clinical program for Star Measure C16: SPC. Members with established cardiovascular disease are at extremely high risk of morbidity and mortality directly related to their chronic condition. The SPC program is designed to reduce the clinical

Medication Adherence for Cholesterol (Statins)

The resounding success in improving the initiation of statin therapy in THP members with CVD and diabetes has led to a third clinical partnership with MRx for the Star Statin adherence measure as well as adherence to diabetes and renin-angiotensinsystem (RAS) antagonists medications.

Non-adherence to medications is an overwhelming burden on the healthcare system. The estimated adherence rate to chronic medications in the U.S. is around 50% and leads to definitively poorer health outcomes.7 Appropriate adherence to prescribed medications effectively improves treatment success, lowers hospitalizations, and lowers overall healthcare expenditures.8

THP has been successful at initiating members on statin therapy, and focus has been shifted to proper adherence in order to optimize member outcomes. Early performance trends for both contracts indicate year-over-year improvement across all three measures with the potential for full Star improvements. Medication adherence benchmarks have risen substantially over the past few years, and a dedicated clinical program to intervene on member-specific barriers has become increasingly important. THP and MRx anticipate promising results generated in the first program year as the adherence program progresses.

Looking Ahead

The Star clinical programs have been successful and valuable for THP of West Virginia. The use of data analytics, clinical strategy, and dynamic prioritization play a crucial role in improving clinical Star measures. A holistic approach to closing the care gap by engaging members, providers, and pharmacies for each measure enables the targeted approach to moving the needle for various statin-related performance measures. Furthermore, the specialization of the team at the Star measure level is a key differentiator for success.

Given that Star Ratings continue to evolve with higher thresholds, measure refinements, and other changes, achieving 5-Star

References

1. “National Center for Health Statistics Mortality Data.” CDC WONDER, 11 Jan. 2023, https://wonder.cdc.gov/mcd.html.

2. Takata, Kohei, et al. “Stabilization of high-risk plaques.” Cardiovascular Diagnosis and Therapy, Aug. 2016, https://www.ncbi. nlm.nih.gov/pmc/articles/PMC4960066/.

3. “Cardiovascular Disease: A Costly Burden for America Projections through 2035.” American Heart Association, 2017, https://www. heart.org/-/media/Files/About-Us/Policy-Research/Fact-Sheets/ Public-Health-Advocacy-and-Research/CVD-A-Costly-Burden-forAmerica-Projections-Through-2035.pdf.

4. Colhoun, Helen M., et al. “Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomized placebo-controlled trial.” Lancet, Aug. 2004, https://pubmed.ncbi. nlm.nih.gov/15325833/.

performance continues to become increasingly challenging. Deep-domain expertise will be vital to understanding the nuances associated with each clinical Star measure and effectively maintaining high performance and quality of care.

Health Plan Overview

The Health Plan is a clinically driven, technology-enhanced, and customer-focused health maintenance organization that manages and improves the health and well-being of its members. Established in 1979, the West Virginia-based company, with offices in Wheeling, Charleston, and Morgantown, West Virginia, and Massillon, Ohio, has offered a complete line of managed care products and services designed to provide healthcare systems and clients with innovative healthcare benefits and plans at a reasonable cost across the mid-Atlantic region and nationally.

5. Egan, Brent M., et al. “2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals.” Journal of the American Heart Association, Aug. 2016, https://www.ahajournals.org/doi/10.1161/JAHA.116.003558.

6. El Sayed, Nuha A, et al. “10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023.” Diabetes Care, 1 Jan. 2023, https://pubmed.ncbi.nlm.nih.gov/36507632/.

7. DiMatteo M. Robin, et al. “Patient adherence and medical treatment outcomes: a meta-analysis.” Medical Care, Sept. 2022, https:// pubmed.ncbi.nlm.nih.gov/12218770/.

8. “Medication Adherence Clinical Reference.” American College of Preventive Medicine, 2011, www.acpm.org/?MedAdherTT_ClinRef.

cancer (metastatic, prior chemotherapy, anti-VEGF, and antiEGFR [if RAS wild-type] therapy) meningococcal pentavalent vaccine (PF-06886992) encorafenib (BRAKTOVI®)

(metastatic, BRAF V600E mutation, in combination with binimetinib)

Abbreviations: AChR-Ab+ = acetylcholine receptor antibody positive; AMD = age-related macular degeneration; AML = acute myeloid leukemia; BLA = biologics license application; BMT = bone marrow transplant; CD = Crohn’s disease; CKD = chronic kidney disease; CMV = cytomegalovirus; DLBCL = diffuse large B cell lymphoma; EGFR = estimated glomerular filtration rate; ESA = erythropoiesisstimulating agent; GVHD = graft vs. host disease; HSCT = hematopoietic stem cell transplantation; IM = intramuscular; IV = intravenous; JIA = juvenile idiopathic arthritis; MDD = major depressive disorder; NDA = new drug application; NSCLC = non-small cell lung cancer; PsA = psoriatic arthritis; PSO = psoriasis; PPD = postpartum depression; RA = rheumatoid arthritis; RPD = rare pediatric disease; R/R = relapsed-refractory; RSV = respiratory syncytial virus; RTOR = real-time oncology review; sBLA = supplemental biologics license application; SC = subcutaneous; SCLC = small cell lung cancer; sNDA = supplemental new drug application; UC = ulcerative colitis; VEGF = vascular endothelial growth factor