Closing the Quality Gap: Medication Adherence for Cholesterol (MAC)

Managing high cholesterol levels through medication

What is High Cholesterol?

Cholesterol is a fat needed for the body to work properly. Too much bad cholesterol, or hyperlipidemia, significantly increases the risk of developing Atherosclerotic Cardiovascular Disease (ASCVD). Routine screening is necessary since cholesterol is often a silent condition. The American Heart Association recommends getting cholesterol levels checked at least once every 4 to 6 years for health adults, and more often for individuals with certain health conditions or family history.

Many strokes and heart attacks are preventable by leading a healthy lifestyle, and when necessary, taking medications to lower blood pressure or cholesterol. Statins are a group of medicines used to lower cholesterol.

Medication Adherence

The patient, provider, and care team must work together to manage a chronic condition. One of the most important ways to control a chronic condition is by taking medication as directed. Nonadherence to statins can lead to poor health outcomes, including cardiovascular disease-related emergency department visits, hospitalizations, healthcare costs, and mortality.

Inadequate communication accounts for 55% of medication nonadherence. To drive healthy outcomes, healthcare professionals must understand the cause of nonadherence. There are a variety of reasons patients choose not to take their medication, including:

8 Reasons for Medication Nonadherence
Download 8 Reasons for Medication Nonadherence Infographic

Research has found that every dollar spent improving adherence saves seven dollars in total healthcare costs. To deliver the most effective care at the lowest cost, ACOs must address medication nonadherence.

Medication Adherence for Cholesterol (MAC)

Adherence to medication is a key driver in managing chronic conditions. As such, medication adherence is included in the Part D component of Medicare Advantage (MA) quality programs. These measures help quantify the quality of care provided to patients enrolled in MA using a STAR Rating scale from 1 (Poor) to 5 (Excellent). Adherence measures are triple weighted, meaning they contribute more heavily to overall program performance than other quality measures.

Plan AffectedQuality Program AffectedCollection & Reporting Method
MedicareCMS Star RatingsPart D Prescription Claims: Pharmacy Data

Medication adherence for Cholesterol (MAC) is defined as:

“Percentage of members ages 18 and older who adherence to their cholesterol (statin) medication at least 80% of the time in the measurement period.”

Exclusions include: members in hospice or using hospice services, end stage renal disease, and dialysis

Improving Medication Adherence

Tips and Best Practices to Close this Care Opportunity:

  • Improve Health Literacy
  • Assess Adherence Barriers
  • Reconcile Chronic Medications
  • Consider 90 Day Prescriptions (when clinically appropriate)
  • Prescribe Low-Cost Generics (when clinically appropriate)
  • Try Home Delivery
  • Organize Medications
  • Sign-up for a Refill Reminder Program at Pharmacy (if available)

Reference: 2023 UHC Quality Reference Guide

8 Reasons for Medication Nonadherence

Download 8 Reasons for Medication Nonadherence Infographic

About the Author

Tresa Shaw, MSN, RN

Tresa Shaw, MSN, RN

Director of Quality at CHESS