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Relationship between medication adherence and other Medicare star rating measures
Eric P Borrelli1, Peter Saad, Nathan E Barnes
1Becton, Dickinson and Company, 3750 Torrey View Ct, San Diego, CA 92130.
The American Journal of Managed Care
|November 25, 2025
Summary
Medicare Star Ratings medication adherence significantly impacts intermediate and process measures. Improving adherence is key for health plans to boost clinical outcomes and financial performance.
Area of Science:
- Health Services Research
- Health Outcomes
- Quality Improvement
Background:
- Medicare Star Ratings incentivize health plans to improve quality of care.
- Medication adherence is a critical component of effective chronic disease management.
- Understanding the link between adherence and performance measures is vital for healthcare quality assessment.
Purpose of the Study:
- To examine the relationship between Medicare Star Ratings medication adherence measures and other intermediate/process measures.
- To assess how adherence to specific drug classes (RASA, antidiabetics, statins) correlates with clinical outcomes.
- To determine the impact of adherence on health plan performance in Star Ratings.
Main Methods:
- Cross-sectional analysis of Medicare Star Ratings data (2015-2025).
- Evaluated relationships between adherence to renin-angiotensin system antagonists (RASA), antidiabetics, and statins with respective clinical outcomes.
- Used odds ratios (ORs) and 95% confidence intervals (CIs) to assess the likelihood of achieving 5-star ratings.
Main Results:
- High adherence to antidiabetic and RASA medications was significantly associated with achieving 5 stars in blood glucose and blood pressure control (ORs > 3.5).
- High statin adherence strongly correlated with 5-star ratings for statin therapy in cardiovascular disease and diabetes populations (ORs > 4.3).
- Health plans achieving 5 stars on adherence measures showed significantly higher odds of achieving 5 stars on related intermediate and process measures.
Conclusions:
- Medicare Star Ratings medication adherence measures are strongly linked to intermediate and statin process measures.
- Targeted interventions to enhance medication adherence are crucial for health plans.
- Improving adherence can lead to better clinical outcomes and enhanced financial incentives through higher Star Ratings.
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