TRICAST Introduces Automated Solution Designed to Improve Poor CMS Five-Star Quality Ratings for Medicare Part D Plans

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Mar 28, 2014, 08:45 ET

MILWAUKEE, March 28, 2014 /PRNewswire/ -- TRICAST, Inc., the nation's leading pharmacy data analytics company, today revealed an automated approach designed to help Medicare Part D Drug Plans improve the star ratings given to them each year by the Centers for Medicare & Medicaid Services (CMS).

"This is a real game-changer for anybody concerned with real-time Medicare Part D plan oversight," says TRICAST President Greg Rucinski.

CMS created the Five-Star Quality Rating System in an effort to educate consumers on quality and make quality data more transparent. The rating gives an overall score on the drug plan's quality and performance:

Drug plan customer service
Member complaints, problems getting services, and improvement in the drug plan's performance
Member experience with the plan's drug services
Patient safety and accuracy of drug pricing

This information is gathered from several different sources. In some cases it is based on member surveys. In other cases, it is based on reviews of billing and other information that plans submit to Medicare, or on results from Medicare's regular monitoring activities.

Starting in 2010, a bonus payment for plans receiving four or more stars was introduced. These bonus payments are also available to plans who are not rated, either because they were too new or had too few enrollees. The bonus payments must be used for further improvements to the plan's benefit offerings.

Rucinski continues: "Our combination of fraud, waste and abuse (FWA), rejection and Part D surveillance systems can help our clients almost immediately improve in 10 of the 15 stand-alone prescription drug plan measures being used in 2014. Nobody else has this capability."

For more information on TRICAST's pending patent, please contact Greg Rucinski at 414.302.9733 or Email.

About TRICAST

TRICAST, Inc. is a leading pharmacy data, analytics, and consulting firm founded in 1997. TRICAST has leveraged more than 25 years of technology and claims processing expertise, extensive client insight and a team of industry experts to offer forward-thinking, full-scope pharmacy benefit oversight solutions to its clients. TRICAST provides audit services as the core of its business, and have assessed multiple types of pharmacy programs. The company's broad experience across payers of widely differentiated size and type, combined with focused experience in pharmacy, enabling the delivery of comprehensive assessments of pharmacy programs. Learn more by going to www.tricast.com.