Abarca Receives PBMI Excellence Award for Quality Improvement Strategies

Mar 7, 2018

Palm Springs, CA – Abarca today announced that it was awarded the Pharmacy Benefit Management Institute (PBMI) Excellence Award for Quality Improvement Strategies for its groundbreaking work on medication therapy management (MTM) programs. The award was based in part on Abarca’s success in helping a Medicare Part D plan improve from 3 to 5 CMS Stars in under 2 years.

“We are thrilled to award Abarca for the dramatic improvements it helped achieve in medication therapy management and comprehensive medical reviews (CMR),” says Jane Lutz, Executive Director of PBMI. “Abarca’s work gives the industry a roadmap for how to significantly improve outcomes and the quality and value of drug benefits.”

The award was based on Abarca’s work on behalf of a Medicare Part D health plan based in Puerto Rico. Abarca implemented an integrated technical and clinical solution for the plan that included:

  • An MTM module that connected medical, clinical notes, and drug utilization data to improve reporting, analytics, resource allocation, and the user experience for clinicians.
  • Highly targeted and customized outreach programs conducted by clinician specialists to improve provider and member engagement, adherence, and outcomes.

This approach enabled the Medicare Part D health plan to achieve an 84% CMR completion rate, a 47% improvement in a little more than a year. CMR completion rates are an important metric CMS uses in awarding Stars for MTM programs.

“We knew that tweaking the MTM model PBMs have been using for years wasn’t going to yield meaningful improvements. It takes a carefully synchronized combination of the right data and expert clinical interventions,” said Jason Borschow, Abarca’s Chief Executive Officer.  “We also had the advantage of a platform that we designed from the ground up to provide the right information, and a world class team of clinicians.”

The MTM program is just one example of how, for more than a decade, Abarca has rejected traditional PBM technology and thinking. This has included launching a smarter technology platform, built from scratch to be more powerful, flexible, and user friendly; intensely focusing on providing clients and members with a better experience; and operating at a higher standard – of reliability, openness, urgency, and accountability.

“It’s an honor to be recognized for excellence by PBMI,” continued Borschow. “But what drives us is making a difference in the health and lives of members, and we couldn’t be happier in what we achieved with this program.”

To read the full case study, click here.


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