Tallahassee – Dec. 22, 2023 – ActualMeds, the industry leader in tech-enabled, high-touch medication management, today shared an update on the company’s major milestones in 2023. The significant advancements, focused on enhancing the InConcert Medication Management (ICCM) platform and tech-enabled services, enable the fast-growing company to meet increasing demand to support high-risk patients of Medicare Advantage Plans in the community and as they move through skilled nursing facilities (SNFs) and post-acute long-term care (LTC) facilities during transitions of care.
Here's what to know and why it matters:
Sweeping industry changes in 2023 were introduced by CMS/Medicare that impact Payers, Providers and Patients across the care continuum.
- With release of its Final Rule for 2024 CMS not only returned to its pre-pandemic stringency around enforcement of quality measures but continues to raise the bar on STARs Rating methodologies and has introduced a new Health Equity Reward structure that will have significant financial impact on Medicare Advantage health plans.
- Similarly, for post-acute Long-Term Care and Skilled Nursing Facilities, on October 1, 2023, CMS enacted new updates to CMS Minimum Data Set (MDS) Nursing Home Comprehensive (NC) 3.0 Item Set version 1.18.11. These changes aim to improve cross-setting data collection, outcome comparisons, data exchange, and quality comparisons within and across post-acute care.
These industry changes require action by stakeholders and ActualMeds is leading the charge where medication management is involved.
- Medication adherence remains a top priority for Medicare Advantage Part D plans because of the strong influence of triple-weighted medication adherence measures and their major influence on overall STAR ratings which are critical not only to clinical and financial success but also help to drive enrollment and business growth. It takes on new significance as ratings are now weighted to high risk Dual Eligible and Low-Income Subsidized populations in which medication management is key to a successful outcome. ActualMeds STARs Adherence solutions continue to outperform industry averages for these high-risk populations.
- Under the new requirements in the post-acute long term care world, skilled nursing facilities must now complete and document a true medication reconciliation when patients are discharged to home, or face penalties. Until now, facilities would be faced with a mostly manual, labor-intensive process to comply. ActualMeds is among the first to bring a solution that integrates EHR/Pharmacy and Claims data to provide a turnkey, cost-effective solution for facilities to complete medication reconciliation at discharge.
ActualMeds Achievements in 2023
- Launching new, technology-enabled STARs medication management service to improve medication adherence at scale, for even the most difficult, high-risk patient populations: The new solution uses automated data handling and reporting, combined with sophisticated algorithms that continuously target high-priority members for outreach. The approach also uses proven best practices to complex, multi-faceted social determinants of health (SDOH) that impact members’ adherence to their medication regimen: Resolving these SDOH barriers like access to transportation or food insecurity, amongst others, often requires a dedicated human interaction to improve adherence.
- High Performance for Medicare Advantage Part D Stars adherence ratings for Low-Income subsidized (LIS) and Dually Eligible (DE) beneficiaries: While CMS reported a decline in overall Part D national Star ratings for the second year, ActualMeds continued to deliver results for MA plans that exceed the national averages for 2024 STARs adherence ratings, with even greater ratings differentiations for work with DE and LIS individuals. The distinction is critical because helping DE and LIS members requires a deep understanding of how to effectively solve for SDOH matters more than ever – and having a scalable, human interaction to increase medication adherence measures for even the most challenging, highest risk members has never been more key to success.
- Ready and able to help MA plans adapt and succeed in the face of new Health Equity Index (HEI) Reward: CMS’s update to the Reward Factor emphasizes an increasing focus on health equity for all and the need for health plans to develop new policies and programs to support this initiative and boost their STAR ratings, especially plans that have traditionally scored lower than the national average and struggled with this hard-to-reach LIS/DE population. Triple-weighted Adherence and other medication management measures take on increased significance for the highest risk populations of LIS and DE enrollees whose clinical risk profiles typically include multiple chronic conditions and the medications critical to their management.
- ActualMeds at the forefront of helping SNF’s fulfill new CMS’ MDS requirements: In response to more stringent coding requirements from CMS that will impact PDPM payments for SNFs, ActualMeds launched a new turnkey solution for medication reconciliation. The new solution augments existing teams and streamlines processes with automation and expert clinical support instead at a time when nursing resources are already stretched thin and many SNFs don’t have the bandwidth to train employees, implement the new process, or ensure that new standards are met.
- Earning HITRUST Risk-based, 2-year (r2) Certification: The ActualMeds team is also pleased to have earned certified status by HITRUST for information security. demonstrating that the organization’s ICCM platform has met demanding regulatory compliance and industry-defined requirements and is appropriately managing This achievement places ActualMeds in an elite group of organizations worldwide that have earned this certification.
Most importantly, as the year concludes, ActualMeds is poised for continued growth and progress in the coming year as the company plans to expand its customer footprint and help more organizations to reach patients at scale. The Company will continue to enhance its capabilities in data interoperability and integration across all post-acute care settings, including the home, and to lead the market in patient-centered medication management.