Health outcomes can be influenced by many factors other than the health care services received, including patient-related characteristics that are both clinical (i.e., pre-existing conditions) and non-clinical (e.g., income, education, age, race or ethnicity). Careful evaluation of risk adjustment is an important consideration to ensure that organizations that care for disadvantaged populations are measured fairly.   

Through its transparent, systematic and consensus-based process, PQA developed risk adjustment recommendations for the three adherence measures used in Medicare Part D (PDC-Diabetes All Class, PDC-Renin Angiotensin System Antagonists and PDC-Statins). As the implementation of risk adjustment for these adherence measures in the Part D Star Ratings program approaches, PQA has a frequently asked questions (FAQ) document that addresses important information on the basics of risk adjustment as well as details specific to risk adjustment of the adherence measures. 

CMS plans to implement PQA’s risk adjustment model for the adherence measures over a three year period. CMS will first display the risk adjusted medication adherence measures for the 2024 measurement year (2026 display page), while the legacy adherence measures remain in the Star Ratings. The risk adjusted measures will replace the existing medication adherence measures beginning with the 2026 measurement year (2028 Star Ratings). CMS also intends to incorporate the risk adjustment operationally to these measures reported by CMS to Part D sponsors in the last monthly patient safety report for the measurement year. 

For more information, see CMS’ 2024 Medicare Advantage and Part D Rate Announcement, plus PQA’s summary of the announcement, as well as the CMS rule for Medicare Advantage and Part D (CMS-4201-F) and PQA’s summary of that rule. 

For more information, read about PQA Measure Use in CMS’ Part D Quality Programs and PQA’s adherence measures.