PharmMD recognizes the value of getting your data right. StarFinder identifies omissions in your PDE file that could mean the difference between one Star Ratings level and the next. Our reconciliation analytics are available on a monthly or annual basis and may be used throughout the measurement period and into the following year when claims run-out.
Driven by PHREDRxTM, our proprietary clinical rules engine, StarFinder’s process reconciles data discrepancies at the individual claims data level and produces detailed reports for rapid corrective action. Our reconciliation reports are unparalleled in the industry. We provide a detailed list of all missing and mis-reported member claims and the specific claim sets that require further analysis. Finding these outliers can prevent potential Star Ratings drops and the resulting negative financial impact. Let us find yours today to improve your Star Ratings.
“When I think of our PBM, I think of formulary management and claims processing. They are generally a fulfillment vendor, and we would typically not rely on them for any services related to care management …”
Director of Quality, Medicare Plan
Health plans recognize that many of their members experience difficulty managing their medication regimen, which has a direct impact on the plans pharmacy quality measurement outcomes. The specific Patient Safety measures in question – High Risk Medications (HRMs), Diabetes Treatment Management, Adherence to Hypertension Medications, and Adherence to Cholesterol Medications – are triple weighted and have the ability to “make or break” a plans overall Star Rating. Combined with a healthy QI score, it is critical that plans deploy efficient, scalable, and tactical programs to meet regulatory requirements.
When it comes to pharmacy related Star Measures, using the right interaction, with the right resource, and providing the best direction at the right time are keys to success. Health plans need access to the most effective strategic partner in the quest for healthy lives; providing the right pharmacy and clinical expertise, predictive guidance and timely personal support. Additionally, to ensure that goals and objectives are aligned, PharmMD’s partnerships are exclusively performance-based.