Five Ways to Win the Medication Adherence Race

The medication adherence landscape has never been more challenging—or more critical. With adherence measures carrying triple the weight of other Star Rating metrics, rising cut points, and 2026's incoming SDS risk-adjusted measures, traditional approaches are falling short. But there is also opportunity for smart health plans to take action with new data-driven strategies. Health plans using precision targeting along with other strategies, supported by technology, are achieving 2-3% above Medicare averages for adherence while others struggle to keep pace.

The Winning Formula: Five Championship-Level Strategies

Just like a championship racing team, achieving five-star medication adherence requires five key components working in perfect harmony. Robocalls or mass text messages won’t solve the problem. However, health plans that commit and master these five strategies are pulling ahead of the competition, while others struggle to keep pace.

Here's your proven roadmap to cross the five-star finish line:

1. Precision Targeting Wins Races

Stop casting wide nets. Start hitting bullseyes. Use automated, data-driven technology to identify the "right patient at the right time." Priority algorithms analyzing daily claims data can pinpoint members at risk of failing adherence measures before it's too late.

Action Steps:

• Implement real-time claims analysis to identify only the members at risk for failing a measure-
• Focus outreach on high-impact members rather than broad populations, eliminating wasted efforts

2. It takes Speed and Smart Timing to Win

It's about moving at the right moment with the right member. Deploy data-driven processes that contact members at optimal moments in their care journey. Historical data only tells part of the story—real-time insights reveal when members need intervention most.

Action Steps:

• Analyze daily claims data to identify emerging adherence risks
• Be ready to make adjustments as race conditions change during the course of the measurement year and adapt outreach cadence to individual member behaviors and preferences

3. Champion Pit Crews Deliver Results

Human connection still drives results in our digital age. Enable pharmacist-led teams to create real relationships with members, not just robocall touchpoints. Your care team should be proficient in both pharmacy and medical channels and ready to address the unexpected.

Action Steps:

• Staff teams with pharmacists and care coordinators who understand local healthcare landscapes
• Go beyond telling members what to do—help them complete the process
• Avoid quality gap closure overload—focus conversations strategically

4. Data-Driven Strategies Cross the Finish Line

Advanced analytics separate winners from losers. Using simple Pass/Fail criteria from the previous measurement year is no better than flipping a coin. Leverage forensic analysis of prior results to identify performance gaps and improvement opportunities. As adherence rates and cut points increase, these small pockets of opportunity become critical differentiators.

Action Steps:

• Conduct continuous performance analysis throughout the measurement year
• Build dynamic models that update frequently based on current dat
• Identify patterns in large provider groups, pharmacies, and VBC partners
• Ask: Is there a viable solution? Is the lift worth the effort? Who else needs involvement?

5. Teamwork Makes the Dream Work

Coordination across the care ecosystem drives breakthrough results. Data interoperability facilitates seamless coordination between health plans, providers, pharmacies, and strategic partners. No single entity can solve adherence challenges alone.

Action Steps:

• Establish clear communication channels with all ecosystem partners
• Create data-sharing protocols that support 24/7 pharmacy operations
• Include pharmacy engagement and provider coordination in gap closure strategies
• Build partnerships that understand healthcare delivery happens locally

The Bottom Line: Time Is Running Out

We're two-thirds through 2025, and the window for improving adherence rates is closing fast. Organizations that act now with proven, data-driven approaches can still achieve five-star success.

The winning formula is clear: Combine precision targeting with smart timing, enable human-centered care teams, leverage advanced analytics, and coordinate across the entire care ecosystem. Health plans implementing these strategies are already seeing results—2-3% above Medicare averages and measurable improvements in Star Ratings.

Are you ready to accelerate your medication adherence strategy? The clock is ticking, but proven solutions exist to help you reach five-star performance before it's too late. Contact ActualMeds today to learn more.