Additional cases for the HealthSpring Star Ratings Program will be released to pharmacies on Monday, November 24th.

Important: This program has early removal activated. Once cases are assigned to a pharmacy, pharmacists have fourteen (14) calendar days to take action and show progress on each case. Cases can be placed into an "In Progress" status by scheduling an appointment with the patient in the MirixaPro℠ platform, printing the patient’s chart, or partially documenting and saving actions taken on the case in MirixaPro.

Each pharmacy will have 30 days from the date the case is originally assigned to complete the opportunity (this assumes the case is put into progress before day (14).

Note: Every HealthSpring Star Ratings case contains a 'Proactive Adherence Counseling' alert. The proactive adherence counseling alert is not specific to a particular medication, and does not indicate that the patient is currently non-adherent to any of the medications in his/her regimen. Rather, the alert is intended to prompt the pharmacist to discuss the importance of adherence to chronic medication therapies generally. The Proactive Adherence alert will never resolve itself due to claims data; therefore, every HealthSpring Star Ratings case is eligible for full reimbursement as long as the case has not been removed due to expiration or after 14 days due to no progress. Please review the 'Proactive Adherence Counseling' section (bottom of page 7) of the attached PSD document for more details.  

Reimbursement: Each case may be served face to face or telephonically and is reimbursed at $35.00 each. Subsequent cases for patients who have previously received a service may be created if HealthSpring determines that a patient would benefit from additional adherence counseling.  

Program Overview   Pharmacists will be presented with targeted quality care intervention cases that focus on Patient Safety, Proactive Adherence Counseling, current Adherence Issues, and Omissions in Care, all of which are described in greater detail below. Cases will be created for patients who HealthSpring has identified as optimal candidates to receive proactive adherence counseling, to reduce the risk of future non-adherence. In addition to requiring proactive adherence counseling, the patients enrolled in the program may currently meet one or more of the following criteria:  

Patient Safety High Risk Medications: Patient is at least 65 years old and appears to be taking one or more medications considered by CMS to pose a high risk of serious side effects in the elderly.  

Adherence Issues Adherence for Cholesterol Medications (Statins): Patient appears to be taking a statin medication, but appears to be non-adherent to this medication therapy, as defined by a Proportion of Days Covered (PDC) less than 80%.

Adherence for Hypertension Medications (ACE-I/ARB/DRI): Patient appears to be taking an Angiotensin Converting Enzyme Inhibitor (ACE-I), Angiotensin Receptor Blocker (ARB), or Direct Renin Inhibitor (DRI) medication, but appears to be non-adherent to this medication therapy, as defined by a PDC less than 80%.

Adherence for Diabetes Medications: Patient appears to be taking a hypoglycemic agent such as a biguanide, sulfonylurea, thiazolidinedione (TZD), DPP-IV inhibitor medication, meglitinide, incretin mimetic agent, or sodium-glucose co-transporter 2 (SGLT2), but appears to be non-adherent to this medication therapy, as defined by a PDC less than 80%.  

Omissions in Care Diabetes Treatment Measure: Patient appears to have diabetes and hypertension, but appears not to be taking an ACE-I, ARB, or DRI.