Understanding Key Medicare Star Measures: Poly-ACH and COB
Understanding Key Medicare Star Measures: Poly-ACH and COB

The Centers for Medicare & Medicaid Services (CMS) uses the CMS Star Ratings system to evaluate Medicare Advantage and Part D plans based on clinical outcomes, patient experience, and plan performance. CMS uses Healthcare Effectiveness Data and Information Set (HEDIS) Measures, developed by the National Committee for Quality Assurance (NCQA), in Star Ratings to evaluate the quality and effectiveness of care provided. 

Across the various health plans, there is a focus on two Star Measures for the Medicare population: Polypharmacy: Use of Multiple Anticholinergic (ACH) Medications in Older Adults (Poly-ACH) and Concurrent Use of Opioids and Benzodiazepines (COB) measures. 

Poly-ACH focuses on medications that should potentially be avoided or used with caution in the older adult population. The measure targets patients 65 years and older taking 2 or more anticholinergic medications with 30 or more days of use during the measurement year (January 1 to December 31). 

 

Poly-ACH inclusion criteria:

  • Numerator: concurrent use of ≥2 ACH medications, each with 2 or more fills
  • Denominator: patients ≥65 years old with 2 or more fills for the same ACH medication

 

Poly-ACH exclusion criteria:

  • Patients in hospice care

 

Poly-ACH results:

  • This measure aims to reduce the use of these medication combinations in the older adult population, for which serious safety concerns have been documented.

 

COB focuses on the percentage of Medicare patients 18 years and older with concurrent use of both opioids and benzodiazepines (30 or more cumulative days). Concurrent use is defined as overlapping day supply of an opioid and benzodiazepine for at least 30 cumulative days during the measurement year (January 1 to December 31). A lower rate represents better performance.

 

COB inclusion data:

  • Numerator: patients with concurrent use of both opioids and benzodiazepines for 30 or more cumulative days during the measurement period
  • Denominator: patients who receive 2 or more prescription claims for opioids filled on 2 or more separate days with a cumulative day supply of 15 or more days during the measurement period

 

COB exclusion criteria:

  • Cancer diagnosis
  • Sickle-cell disease
  • Receiving hospice or palliative care

 

By understanding and monitoring these key Medicare Star Measures, providers can help ensure safer prescribing practices and improve overall outcomes.