Best Practices in the Medicare Rx Benefit

Jul 22, 2013
Express Scripts' best practices for Medicare Part D plans, highlighting programs to enable better health decisions, while ensuring quality and compliance.
  • Medicare
  • Caregivers
  • Seniors

Success for Medicare prescription drug plans requires deep expertise in quality, compliance and member service. The Centers for Medicare and Medicaid Services (CMS) recently invited Express Scripts to share our approach to all three during a first-of-its-kind best practice sharing session.

The CMS webinar highlighted clinical, organizational culture and health information technology best practices from select high-performing Medicare plans. All CMS Part C and Part D sponsors were encouraged to attend, but the Express Scripts Medicare™ Prescription Drug Plan (PDP) was one of just six plans – and the only PDP – invited to present to more than 1,300 attendees on June 25.

Express Scripts serves millions of Medicare-eligible members on behalf of health plan clients, self-funded insurers leveraging an Employer Group Waiver Plan (EGWP), and the national Express Scripts Medicare PDP, which has consistently earned high CMS Star Ratings. In 2013, the plan earned 4 Stars* – the highest of any nationally offered PDP.

Compliance, Safety and Education = Improved Outcomes

Drawing from a decade’s worth of experience serving the unique needs of Medicare beneficiaries, the Express Scripts Medicare team welcomed the opportunity to share our best practices.

During two panel discussions, we highlighted our programs to enable better health and safety decisions while ensuring quality and compliance at all times:

The value of Medication Therapy Management (MTM) for enhancing our members’ overall health while reducing wasteful spending through targeted physician and member outreach and education.

Advanced health and safety solutions that help us rapidly identify and correct gaps in care, drug safety concerns or omissions of care. RationalMed®, which leverages integrated pharmacy and medical data, helps improve patient safety while lowering both medical and prescription drug costs.

Our approach to a compliance-first culture, including continuous compliance and regulatory guidance monitoring led by a team of Medicare experts, supported by a cross-functional rapid response process and robust documentation tying policy and procedures to business processes.

It’s taken significant investment in specialized technology, people and processes to ensure Express Scripts consistently delivers the quality and compliance required for longevity and high performance in this unique market.

We’re committed to continuing that investment, developing and expanding programs that employ Health Decision ScienceSM to help Medicare beneficiaries and plan sponsors make better decisions and realize healthier outcomes.

*Rated 4 stars in 49 states for overall quality and service for 2013. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

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