Healthcare payers are tasked with reducing costs, increasing efficiencies, and improving quality performance and individual health outcomes. By proactively identifying and addressing gaps in care, payers can elevate Centers for Medicare and Medicaid Services (CMS) Star Ratings and achieve better patient outcomes.
In this article, we will focus specifically on Statin Use in Persons with Diabetes (SUPD)—a Medicare Advantage Part D quality measure that tracks the percentage of diabetic members who filled a statin during the measurement year—and the steps health plans can take to drive performance improvements.
SUPD 101: What It Is and Why It’s Important
Statins are a class of medications prescribed to reduce plaque build-up and bring down cholesterol levels, ultimately decreasing the risk of heart attack or stroke. Because patients with diabetes are at a greater risk of having issues with high cholesterol, doctors often prescribe statins to stop plaque formation, keep existing plaque from worsening, and prevent the development of clinical atherosclerotic cardiovascular disease (ASCVD).
In an ideal world, this would almost always be the case. However, diabetic patients are not always prescribed statins—even when it’s clear they could benefit from said therapy. Recognizing this as a persistent and problematic gap in care, payers are looking for ways to increase statin use among their diabetic patient populations to improve health outcomes and SUPD quality scores.
How to Improve SUPD Quality Performance
So how exactly can payers close gaps in care and improve SUPD quality performance? It all comes down to outreach, education, and engagement:
Intervening with Provider Outreach
One way to improve SUPD metrics is to intervene with direct provider outreach. By using claims data to identify at-risk diabetic patients and plan members who are not currently taking a statin, payers can pinpoint which prescribers to target for a SUPD intervention.
Whether it’s via a live call, automated fax, or an electronic script (e-script), provider interventions are a great way to increase statin use among diabetic patient populations. Doing so will help boost statin prescriptions for both the patient in question and for all the diabetic patients the prescriber treats.
Educating Patients on the Benefits
Sometimes, payers prefer to reach out to patients directly to educate them on the benefits of a particular therapy. In this scenario, a health plan can either provide education that the patient can then relay to their prescriber, or educate on the benefits and request permission to contact the prescriber directly.
There is no one-size-fits-all approach. Whether payers (and, in other cases, pharmacists) prefer to intervene themselves or encourage their patients to do so depends entirely on each healthcare organization’s comfort with a specific intervention tactic.
Using AI to Maximize Interventions
With so many different channels available for interventions—not to mention countless messaging tactics—it can be challenging to choose the most effective, cost-friendly, and efficient approach. That’s why artificial intelligence (AI) is a true game-changer.
More and more, healthcare organizations are using AI to maximize the effectiveness of their patient interventions. Whether the goal is to improve SUPD, another statin-related measure, or something else entirely, AI can help determine the right intervention channel, messaging, timing, and frequency to have the greatest impact.
Elevating SUPD Performance with Smart Data
AllazoHealth leverages “smart data” supplemented by AI, predictive analytics, and machine learning to improve individual patient outcomes and quality performance. Payers and PBMs have closed gaps in care and boosted quality scores using AllazoHealth’s AI Engine.
But don’t just take our word for it. Download our case study to see for yourself how Blue Cross Blue Shield of North Carolina elevated performance and reduced costs with AllazoHealth’s AI technology.
