CMS HEDIS and Stars Pharmacy Overview—Medication Adherence, Statin Use in Patients and More

Activity description

The Centers for Medicare & Medicaid Services (CMS) Medicare Part D medication adherence and stars measures use a five-star quality rating system to measure the experiences Medicare beneficiaries have with their health plan and health care system. Medication-use-related measures, such as medication adherence, are weighted heavily when determining a prescription drug plan’s overall star rating, as poor patient adherence to medications for chronic conditions often leads to worse clinical outcomes and poorer quality of life. Health care professionals (HCPs) can better improve their performance and positively impact patient outcomes by understanding how this performance is measured and the intent behind these measurements. Participants in this activity will learn how CMS measures medication adherence, its role in patient qualification status, impact on claims algorithms, and potential caveats of these determinations. Strategies to address common barriers to medication adherence will be discussed, along with best practices that may improve adherence. In addition, the five measures included in the 2021 Medicare Part D star ratings, including those regarding medication adherence for diabetes, hypertension, cholesterol, as well as statin use in persons with diabetes, will be reviewed.

Provided by
This activity is jointly provided by OptumHealth Education and OptumInsight RQNS.

Commercial support
There was no commercial support received for this activity.

Required hardware/software
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Target Audience

This activity is designed to meet the educational needs of physicians, PAs, nurses, nurse practitioners, psychologists, social workers, pharmacists and pharmacy technicians who are interested in learning how to improve performance and positively impact patient outcomes through a review of the Centers for Medicare & Medicaid Services (CMS) Medicare Part D Medication Adherence and Stars Measures’ five-star quality rating system, including how to best apply this to current practices.

Learning Objectives

At the end of this educational activity, participants should be able to:

  • Review the Centers for Medicare and Medicaid Services (CMS) medication adherence and stars measures, including the new measures for diabetes, hypertension, and cholesterol included in the 2021 star ratings.
  • Identify the intent behind these measures, along with potential caveats that may be encountered. 
  • Describe how CMS measures medication adherence, how it is calculated, and its roles in patient-qualification-status determination and claims algorithms.
  • Discuss strategies and best practices that can improve medication adherence in health care professionals’ patient populations.

Additional Information

Activity summary
Available credit: 
  • 2.00 ACPE - Pharmacists
  • 2.00 ACPE - Pharmacy Technicians
  • 2.00 AMA - Physicians
  • 2.00 ANCC - Nurses
  • 2.00 APA - Psychologists
  • 2.00 Attendance - General Attendance
  • 2.00 ASWB - Social Workers
Activity opens: 
Activity expires: 

Levette Fleming, PHARMD, BS, RPh
Associate Director of Pharmacy
UnitedHealthcare M&R Georgia

About the presenter
Levette Fleming, PharmD, has been in the pharmacy industry pathing across various industries: Veterans Association, geriatric and pediatric specialty, federally qualified health centers, managed care—HMOs, pharmaceutical executive sales, hospitals and retail. She joined Optum Insight over six years ago where today she leads the operations and strategy departments, supporting UnitedHealthcare M&R market in Georgia supporting almost 300K patients. Dr. Fleming is a driven and strategic leader with a focus on the end results of bettering patient care and outcomes in her daily practice. She has her doctorate in pharmacy and is a registered pharmacist.

Activity planners
Elizabeth V. Albert, MD 
Clinical Activity Manager
OptumHealth Education

Levette Fleming, PHARMD, BS, RPh
Associate Director of Pharmacy
UnitedHealthcare M&R Georgia

Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, OptumHealth Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.

The activity faculty and planners have no financial relationships to disclose.

Method for calculating CE credit
CE credit was calculated by the complexity of content.

Accreditation statement
Joint Accreditation LogoIn support of improving patient care, this activity has been planned and implemented by OptumHealth Education and OptumInsight RQNS. OptumHealth Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Credit designation statements

The participant will be awarded up to 2.00 contact hour(s) of credit for attendance and completion of supplemental materials.

Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.

Pharmacists/Pharmacy technicians
This activity is approved for 2.00 contact hours ([0.20] CEU) in states that recognize ACPE.
Attending the full program will earn 2.00 contact hours.
Unique Activity Number(s): JA0007123-9999-21-312-H04-P/T

OptumHealth Education designates this enduring activity for a maximum of 2.00 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.

OptumHealth Education is approved by the American Psychological Association (APA) to offer continuing education for psychologists. OptumHealth Education maintains responsibility for this program. 2.00 CE hours.

Social workers
ACE LogoAs a Jointly Accredited Organization, OptumHealth Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. OptumHealth Education maintains responsibility for this course. Social workers completing this course receive 2.00 enduring continuing education credits.

Counselors and/or marriage and family therapists
CA: The Board of Behavioral Sciences has deferred CE course approvals to APA and ASWB for its licensees. See those approvals under Psychologists and Social Workers.
Other States: If your state is not specifically listed, nearly all state Counselor and MFT boards accept either APA or ASWB approval, or are reciprocal with other state licensing board approvals, such as those listed below. Check with your board to be sure.

A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been preapproved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization from which they wish to obtain credit.

Available Credit

  • 2.00 ACPE - Pharmacists
  • 2.00 ACPE - Pharmacy Technicians
  • 2.00 AMA - Physicians
  • 2.00 ANCC - Nurses
  • 2.00 APA - Psychologists
  • 2.00 Attendance - General Attendance
  • 2.00 ASWB - Social Workers
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