Contributor: A Fresh Approach to Medication Adherence—Best Practices for Improving Outcomes and Star Ratings

In today’s value-based care environment, there’s no debate—medication adherence is one of the most powerful drivers of improved health outcomes, lower costs, and stronger Star Ratings. For Medicare Advantage (MA) plans, adherence measures are triple-weighted, directly impacting performance, financial incentives, and member satisfaction.

Yet despite its importance, traditional approaches to medication adherence often fall short. One-size-fits-all messaging and reactive strategies simply don’t meet the needs of diverse member populations—nor do they align with the evolving expectations of consumers.

To succeed, MA plans need a fresh, innovative approach that moves beyond conventional methods. Personalized engagement, behavioral science–based techniques, and intelligent data-driven strategies are now essential for addressing the real-world challenges that stand in the way of adherence.

Medication adherence: a persistent challenge for MA plans

Image credit: AdhereHealth

With more than 90% of older adults living with at least 1 chronic health condition, and up to 65% of these adults requiring multiple medications to manage these conditions, medication adherence is a complex, ongoing challenge.

The Medicare Star Ratings framework defines successful adherence as members maintaining medication coverage for at least 80% of the year—a benchmark that is directly tied to triple-weighted adherence measures and financial incentives for health plans.

The barriers to adherence are well known, but they’re not static. Clinical factors alone don’t tell the full story. Social determinants of health (SDOH) challenges, like transportation issues, financial instability, housing insecurity, and health literacy gaps all play a significant role. Behavioral barriers—such as forgetfulness and concerns about medication side effects—further complicate the issue.

As MA plans navigate a rapidly growing and aging member base, traditional, one-size-fits-all adherence programs are no longer enough. Plans must adopt new, proactive strategies that are data-driven, member-centric, and adaptable to evolving challenges.

Best practices for transforming medication adherence strategies

1. Data-driven targeting: identifying members most at risk

Successful medication adherence starts with intelligent, proactive member identification. Instead of waiting for gaps to emerge, plans can leverage data analytics platforms that incorporate SDOH data, as well as clinical, claims, and pharmacy data. This type of tech-based support helps flag members with potential adherence challenges, prioritizing them for targeted outreach before they exhibit a dip in measurable adherence rates.

It also helps to prioritize early intervention. For example, during the first quarter of the year when adherence benchmarks reset, plans should focus on members with prior-year adherence below 80% PDC, as well as members who haven’t yet fallen below this adherence benchmark but have missed a medication refill. Proactive engagement at these critical points in time help members stay on track early—preventing quality measure deficits that compound over time.

Tracking and refining interventions based on real-time adherence data can ensure outreach remains relevant and impactful throughout the year. Powerful data platforms are capable of tracking clinical interventions, identifying member-specific barriers, and monitoring progress. This dynamic, member-centric approach continuously refines targeting strategies, supporting future interactions, and improving results.

2. Omnichannel outreach: meeting members “where they are”

Live telephonic member conversations are powerful, but traditional phone calls aren’t enough. An omnichannel approach that aligns with member preferences is key to driving engagement.

Personalized, omnichannel outreach strategies enable plans to connect with members through their preferred communication methods. By leveraging multiple channels—such as phone calls, email, text messaging, feeds, and direct mail—plans can establish an effective outreach strategy that increases the likelihood of engagement.

Image credit: AdhereHealth

Meeting members “where they are” ensures a more inclusive and equitable approach for diverse populations, including rural, elderly and technologically underserved populations.

To prevent member fatigue, plans should adopt a data-driven "smart outreach" approach, prioritizing high-value messages such as refill reminders and care gap alerts. This thoughtful strategy strengthens trust, enhances member experiences, and positions health plans for success with their Star Ratings.

3. Behavioral science: driving sustainable behavior change

Medication adherence isn’t just a logistical challenge—it’s a behavioral one. And behavioral science–based strategies help plans understand and address the cognitive and emotional factors influencing adherence. When combined with advanced analytics to identify high-risk members, plans can better understand the breadth of barriers members are facing and implement evidence-based approaches to solve for them.

By addressing behavioral and SDOH strategies together, plans can develop a myriad of tailored engagement techniques, such as motivational interviewing, timely reminders, simplified messaging or reframing the long-term benefits of adherence in more compelling ways.

The holistic approach of aligning robust data analytics with behavioral science approaches helps health plans drive sustained member behavior change, leading to long-term adherence, not just short-term compliance.

4. Care team integration: expanding the circle of support

Adherence improves when members feel supported. Plans should engage prescribers, pharmacists, and care coordinators to reinforce medication adherence messaging. By working together on behalf of a member, plans can incorporate a powerful strategy for personalizing care, driving member engagement and supporting healthy behaviors.

Physicians and nurses play a critical role in emphasizing the importance of medication adherence during appointments, whereas pharmacists offer hands-on support for managing complex medication regimens and addressing potential drug interactions. Incorporating a trusted, familiar support network into medication adherence efforts ensures members are more likely to respond to outreach, fill prescriptions on time and participate in health-promoting activities like wellness visits and preventive screenings.

This team-based approach, with an aligned source of information amongst parties, ensures members receive consistent, trusted guidance, increasing the likelihood of adherence.

Kempton Presley, MPH, MS | Image credit: AdhereHealth

5. Connecting members to SDOH resources

For many members, adherence isn’t about willingness—it’s about access. Plans can bridge social and economic barriers by connecting members with resources that allow them to directly address and resolve the SDOH challenges standing in the way of their medication adherence.

When members have access to support resources such as meal delivery programs, transportation assistance, or financial aid for prescription copays, they are more likely to remain engaged in their care plans and adhere to prescribed treatments.

Plans should consider partnering with a holistic solutions platform that facilitates connections to services and support to directly address SDOH challenges. For instance, connecting a member with a ride service to help them address frequently missed prescription refills due to transportation issues can prevent adherence issues before they escalate. Understanding additional member incentives for using this transportation benefit (eg, grocery shopping) maximizes the likelihood of adoption. This proactive approach helps members stay on track with their medications and avoid health complications that could arise from missed doses.

By addressing the root causes of nonadherence, plans can eliminate obstacles before they disrupt medication routines.

A smarter, member-centric approach to medication adherence

Medication adherence has always been essential for improving outcomes, reducing costs, and achieving strong Star Ratings, but success in today’s health care landscape requires a more strategic, member-focused approach.

Leading MA plans are moving beyond outdated, one-size-fits-all models and embracing data-driven, predictive engagement to proactively support at-risk members, personalized omnichannel outreach that aligns with individual communication preferences, and behavioral science–based interventions designed to drive sustained behavior change. Additionally, they are strengthening care team coordination to reinforce adherence messaging and leveraging SDOH-informed solutions to remove real-world barriers that prevent members from staying on track with their medications.

By adopting these best practices, MA plans can improve member experiences, enhance health outcomes, reduce avoidable utilization, and strengthen Star Ratings performance—all while ensuring medication adherence strategies continue to evolve to meet the needs of today’s Medicare population.