Addressing Social Risk Factors in Medication Adherence Outreach to Drive Health Equity

Session Description: Unfavorable social-risk factors (SRF) negatively impact medication adherence and health outcomes. CMS recently released a framework to advance health equity and improve outcomes for disadvantaged beneficiaries. The CMS 2024 Final Rule for the Medicare Program confirmed replacing the current Reward Factor with a health equity index. This incentivizes health plans to focus on delivering higher quality of care across a subset of medication adherence and other Star Ratings measures for members with SRFs.

For over a decade, RxAnte has partnered with Medicare Advantage plans to utilize predictive analytics to drive medication adherence and cost savings in at-risk populations. This session will describe a new approach to using claims data and publicly available geo-coded SRF data to develop effective outreach that improves medication adherence and reduces health disparities in an MAPD population. Working with our payer partners UPMC and Kaiser Permanente of Colorado, RxAnte developed a supervised machine learning model to identify at-risk SRF cohorts. Tailored outreach was developed by the plans to identify and address barriers to medication adherence and other health behaviors.

Attendees will learn the impact of SRF on medication adherence and how to develop actionable outreach programs that can deliver better care to at-risk patients. Attendees will review outcomes from these pilot programs and gain an understanding of how targeted SRF personas compare to usual-care outreach.