This project was supported by the Pharmaceutical Research and Manufacturers of America Foundation (PhRMA). The content is solely the responsibility of the authors and does not necessarily represent the official views of PhRMA. The funding agency was not involved in research design, analysis, or reporting results. Funding was obtained by Abughosh. Holstad provided a consultation regarding the MI guide and provided the MI training. Study concept and design were contributed by Abughosh and Fleming, along with Serna, Esse, and Holstad. Serna, Esse, Mann, Holstad, and Masilamani collected the data, and data interpretation was performed by Abughosh, Wong, and Esse. The manuscript was written by Abughosh, Wong, and Esse and revised by Masilamani and Holstad, along with the other authors.

Cardiovascular disease (CVD) remains a major global cause of morbidity and mortality, affecting 40% of women and 50% of men over their lifetime. 1,2 CVD is also a leading contributor to disease burden in adults aged 60 years and older, accounting for around 30% of the total burden. 3 Statin medications are the most widely used lipidlowering agents, with compelling clinical trial data demonstrating effectiveness in primary and secondary prevention of CVD as well as evidence showing significant reduction of cardiovascular-related mortality. 4-10 Despite these well-documented benefits, adherence and persistence to statins remain substandard. 4,11 High discontinuation rates have also been reported, with 50% of patients discontinuing within 1 year and increasing discontinuation over time, especially among elderly patients. 4,[11][12][13][14][15] In the United States, 33%-69% of all medication-related hospital admissions are attributable to poor medication adherence, resulting in an annual estimated cost of $100 billion. 16,17 About 40%-86% of older adults are nonadherent, [17][18][19] which is concerning because they usually experience a higher number of illnesses, use more medications, and are at risk of age-related cognitive decline. 20,21

Overall, pharmacist-written recommendations were commonly accepted by physicians. Recommendations for heart failure were less likely followed versus those for diabetes. Since most recommendations for heart failure concerned changing drugs within the beta-blocker class, physicians may not have seen the value in modifying current therapy. This finding points to a potential need for physician education. Further research with larger samples is warranted to increase the power to identify significant differences in other variables that may need to be addressed in order to increase the rates of recommendation acceptance and improve patient care.

BACKGROUND: Quality compensation programs (QCPs), also known as payfor-performance programs, are becoming more common within managed care entities. QCPs are believed to yield better patient outcomes, yet the programs lack the evidence needed to support these claims. We evaluated a QCP offered to network primary care physicians (PCPs) within a Medicare managed care plan to determine if a positive correlation between outcomes and the program exists.

BACKGROUND: Health plans and providers can increase quality by improving adherence to chronic disease medications included in star ratings among Medicare Advantage Part D (MAPD) plan enrollees. Research is needed to evaluate effective means of collaboration between health plans and providers. The Medication Adherence Tracker (MAT) is a health plan initiative to help primary care providers use outreach to improve their patients' adherence.OBJECTIVE: To quantify the contribution of structural and process factors on the success of a health plan-initiated tracking system in improving chronic disease medication adherence over 6 months. METHODS:The MAT quality improvement initiative was carried out in South Texas from June to December 2016. Health plan pharmacists used claims data to identify MAPD enrollees at risk of nonadherence to triple-weighted star medications: renin-angiotensin system antagonists, oral diabetes medications, and statins. Actionable reports were delivered biweekly to each provider, either by fax or in person, by embedded health plan nurses. Multivariable regression was used to evaluate sociodemographic and clinical factors as well as the role of provider outreach in increasing paid pharmacy claims and medication adherence as measured by proportion of days covered (PDC) > 0.8. RESULTS: Of 3,542 patients in 5 Texas physician-organized delivery system groups whose 67 providers received tracking reports from June through December 2016, 1,901 (54%) patients had more than 1 related prescription, and 3,064 (87%) received provider outreach on at least 1 prescription. 2,493 (70%) had at least 1 paid pharmacy claim. Provider outreach was associated with greater likelihood of paid prescription claims (relative risk [RR] = 4.59, 95% CI = 3.74-5.62) and greater year-end adherence (PDC > 0.8, RR = 1.86, 95% CI = 1.63-2.12) in multivariable predictive models. 95% CIs for age, gender, low-income subsidy eligibility, and number of prescriptions did not exclude the null value.CONCLUSIONS: Provider engagement is critical to effective health planprovider partnerships to overcome barriers, change behavior, and improve chronic disease care quality and population outcomes.