The Voice of Lisa Erwin

Lisa Erwin

About Lisa Erwin

Lisa Erwin is a Senior Consultant of Pharmacy Services at Gorman Health Group (GHG).In this role, she assists Medicare Part D plans in optimizing their Centers for Medicare & Medicaid Services (CMS)-mandated clinical offerings including Star Ratings, Medication Therapy Management, and Utilization and Overutilization programs. Read more

How Will Your MTM Programs Impact Star Ratings in 2018?

Lisa Erwin

In 2015, plans were met with the first “a-ha” moment when the Centers for Medicare & Medicaid Services (CMS) published the 2016 Star Ratings Medication Therapy Management (MTM) Comprehensive Medication Review (CMR) completion Star Ratings cut points indicating, at least when it came to delivering a completed CMR to a member, some plans were clearly outperforming others. Since then, the stakes have continued to be raised on MTM vendors or those conducting MTM in-house to meet the challenge of how to cost effectively improve their delivery of completed medication reviews. This is especially challenging given the varying nature of plan delivery types and the vastly different member demographics for whom they provide services.

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PBM-Supported Part D Measures Impact Quality Bonus Payment Revenues

Lisa Erwin

Regulatory time frames around coverage determinations and appeals have existed since the inception of the Part D benefit. Timely access to medications has been a hallmark of the “member protective” stance the Centers for Medicare & Medicaid Services (CMS) has taken since Day 1. So how is it, even 10+ years into the delivery of the program, compliance with these time frames continues to be the bane of health plan Compliance and Star Ratings teams?

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Star Ratings: Medication Management Is Not Just for D Ratings Anymore!

Lisa Erwin

As a pharmacist and Star Ratings Senior Consultant for Gorman Health Group, whenever I am asked to provide insight on how to achieve or maintain Star Ratings success, the conversation has been limited to the “D” part of the metrics, and the folks involved with Medicare Advantage (MA) and Healthcare Effectiveness Data and Information Set (HEDIS®) kind of glaze over and mumble something like, “That’s for the Pharmacy folks to deal with.” That attitude has always been somewhat befuddling to me considering the historical and ever-increasing impact of appropriate clinical management of medications on many HEDIS® measures and the quality conversation in general. Equally confusing to me has been the willingness of many pharmacists to relinquish the ownership of the medication-related HEDIS® measures to Quality, Case Management, or other teams.

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