Star Rating Cut Points (UPDATE FOR 2019)

Every year CMS evaluates the data they receive from plans to check whether thresholds need to be updated for the upcoming calendar year. They evaluate both adherence measures (Diabetes, Hypertension, Cholesterol) and display measures. Updates in these measures aim to increase overall patient health as well as keep healthcare professionals accountable for their patients’ outcomes.

Since PrescribeWellness displays these adherence and safety measures on our Patient Engagement Center, we also must update our ratings and calculations each year to provide our you with accurate, actionable analytics.

When it comes to evaluating Star Rating thresholds, CMS recognizes two different thresholds; PDP and MA-PDP. PrescribeWellness always uses the thresholds that are the stricter of the two for each metric. These updates are detailed below for the 2019 updates.

Updates for 2019:
  • Updates to Diabetes Star ratings thresholds (PDP):
    • 1 star – less than 82%
    • 2 star – greater than or equal to 82% to less than 84%
    • 3 star – greater than or equal to 84% to less than 86%
    • 4 star – greater than or equal to 86% to less than 88%
    • 5 star – greater than or equal to 88%
  • Updates to Hypertension Star ratings thresholds (PDP):
    • 1 star – less than 84%
    • 2 star – greater than or equal to 84% to less than 86%
    • 3 star – greater than or equal to 86% to less than 87%
    • 4 star – greater than or equal to 87% to less than 89%
    • 5 star – greater than or equal to 89%
  • Updates to Cholesterol Star ratings thresholds (PDP):
    • 1 star – less than 80%
    • 2 star – greater than or equal to 80% to less than 82%
    • 3 star – greater than or equal to 82% to less than 84%
    • 4 star – greater than or equal to 84% to less than 88%
    • 5 star – greater than or equal to 88%
  • Update Statin Use in Persons with Diabetes (SUPD) to be a Star measure (MA PDP)
  • *Please note that 2019 is the FIRST year that this category will be assigned a Star Rating.
    • 1 star – less than 72%
    • 2 star – greater than or equal to 72% to less than 76%
    • 3 star – greater than or equal to 76% to less than 80%
    • 4 star – greater than or equal to 80% to less than 83%
    • 5 star – greater than or equal to 83%

Patient Engagement Center

Like to organize? Us too! Patient groups is a great way to segment your patients into any unique categories you may have. With this update, you can now assign patients to multiple patient groups. Need to create new groups? No problem – just call into our Client Solutions team to create patient groups. You can then assign patients to their group(s) using the patient profile.

Users will now be able to see notes within the Custom Calendar within the day view of events (illustrated below).

PrescribeCare  

Need to update encounter info? No problem! You can now edit an encounter after it is completed. Only certain fields will be editable. This will help your pharmacy in multiple cases, such as when you attempt to bill for a program and the claim is rejected, so it has to be re-submitted.

PharmacyGrowth & Communications

We don’t want to over-communicate. Now, any message telling you that a medication was successfully pushed-to-queue will be marked as “read” in your Message Center!

Keep your contacts updated! You can now see the status of a patient’s phone number on their patient profile. For instance, if a voice campaign is unsuccessfully sent to a patient because the number is no longer in service, that will be notated near the patient’s phone number on their profile (illustrated below).

Custom Calendar

Great news! You can now create recurring events on your custom calendar. To do so, just navigate to the Custom Calendar and then click Add Event. A window will appear (illustrated below).

Once you have added all details, click the Recurrence tab to select the recurrence frequency, and an end date (illustrated below).

Bug fixes

Some users were experiencing an issue where their wrong primary email was displaying on the Settings page. This has been addressed.

Some users were experiencing an issue that a physician fax was sent multiple times. This has been addressed.

Certain users using Internet Explorer 11 were having display issues when logging in. This has been addressed.

OnDemand Messages sent from  the patient profile were not showing in a patient’s communication history. This has been addressed.

Some users were experiencing issues with PharmacyReach, such as Facebook posts posting at sporadic times, or image previews not displaying properly. This has been addressed.

Some users were experiencing issues when exporting data from PrescribeCare. This has been addressed.

Some users were experiencing an issue with importing provider information in PrescribeCare. This has been addressed. 

Some users were experiencing an error when copying encounter data. This has been addressed.