The Centers for Medicare & Medicaid Services (CMS) requires Part D sponsors to incorporate a medication therapy management program (MTMP) into their benefit structure.1 MTM is a member-centric approach to improve medication use. Beneficiaries are enrolled in the MTMP if they have multiple chronic diseases, take multiple Part D medications, or have annual drug costs that exceed a predetermined threshold.
- Annual comprehensive medication review (CMR): This review is an interactive person-to-person or telehealth medication review and consultation conducted in real time between a patient and/or an authorized individual, such as a prescriber or caregiver, and a pharmacist or other qualified provider. The review is designed to improve patients’ knowledge of their prescriptions, over-the-counter (OTC) medications, herbal therapies, and dietary supplements; identify and address problems or concerns that patients may have; and empower patients to self-manage their medications and their health conditions.
- Quarterly targeted medication review (TMR): This is a review of medications to assess medication use and identify and address specific or potential medication-related problems.
MTM Comprehensive Medication Review (CMR) completion rate is a Part D process measure that CMS incorporated into its Star Ratings in 2016. Since implementation, the cut point for a 5-star rating has continued to increase.
In collaboration with each plan sponsor, PerformRx implemented an MTM program under three of its PBM contracts, representing two Medicare Advantage prescription drug plans (MAPD) and one prescription drug plan (PDP). Both MAPD plans received ratings between 2 and 3 stars from 2019 to 2021, based on data collected between 2017 and 2019. During the same time frame, the PDP received rat ings between 4 and 5 stars.
PerformRx’s goal was to achieve a 5-star CMR completion rate across all three contracts. Based on the increasing trends in the cut point year-on-year, this goal would be achieved through a CMR completion rate of close to 90% for the two MAPD plans, and a rate of 75% for the PDP.
This program was implemented on January 1, 2020. The plan was responsible for identifying beneficiaries who met criteria for inclusion into the MTM program. PerformRx then received weekly data extracts identifying newly eligible beneficiaries and claims data. We collaborated with the health plan to develop new data transfer processes and protocols to support the program. These newly eligible beneficiaries were then enrolled into our MTM program and sent an engagement packet containing:
- Information about the program
- A questionnaire to gather information such as:
- Over-the-counter drug or supplement use
- Medication allergies
- Date of annual wellness visit
- Best days and times to contact the beneficiary
The engagement packet captured information that was not available in claims data, which enabled us to provide additional support for the program.
Our outbound telephonic campaign to engage beneficiaries and complete CMRs began immediately upon enrollment and was managed by our dedicated team of pharmacists. For beneficiaries who we were not able to reach after multiple attempts, we employed various strategies to obtain working phone numbers:
- Contacting the member’s pharmacies
- Contacting the member’s providers
- Collaborating with the health plan to obtain alternate phone numbers
If beneficiaries were not available to complete a CMR with the pharmacist when they were first contacted, we offered to call back at another time that was more convenient for them. For beneficiaries residing within the same household, we attempted to complete all CMRs during the same outreach if possible.
The health plan provided us with long-term institutional data for beneficiaries when applicable. We utilized this data to complete CMRs for beneficiaries residing in long-term care facilities. When possible, we grouped the beneficiaries by location to increase efficiency by minimizing multiple outreaches to the same facility. If requested by the facility, we also scheduled callbacks for times that worked best for the clinical staff at the facility.
We outreached to the plan on a weekly basis to obtain information related to authorized representatives for beneficiaries whose caregivers reported they would complete the CMR on behalf of the beneficiary. We then followed up with additional CMR offer attempts once documentation of this information was confirmed.
Our team worked alternate schedules, including evenings and weekends, to help us to connect with additional beneficiaries whom we might not have been able to reach during normal business hours.
Through the course of the COVID-19 pandemic in 2020, our team continued to focus intensive efforts on this program. We were able to provide additional resources to beneficiaries related to COVID-19 in addition to completing CMRs.
Our clinical team coordinated with the plans to develop a process to refer beneficiaries to the health plan’s care management team for care coordination that was outside the scope of pharmacy, such as transportation and appointment scheduling. This referral process expanded the resources that were available to the member.
Close program monitoring allowed us to effectively manage our resources to enable us to reach a high CMR completion rate for all three plans. In addition to this, we were able to identify and resolve data issues throughout the year to ensure that accurate data was being utilized for the program.
As shown in Table 1 below, we were able to achieve a high CMR completion rate for all three plans.
As shown in Figure 1, compared to the prior three years, PerformRx was able to significantly increase the CMR completion rate in 2020 (year one of program implementation), which will be reported for contract year (CY) 2022. For Plan 1, the CMR completion rate increased by 12%, which met the cut point for a 5-star rating for CY 2021.. Similarly, for Plan 2, the rate increased by 14%, again meeting the cut point for a 5-star rating. Both Plan 1 and 2 received a 3-star rating in CY 2021. For Plan 3, we increased the rate by 13%, which exceeded the cut point for a 5-star rating for CY 2021.2
In addition to the high CMR rates achieved in the program, beneficiary feedback was also positive, which will help contribute to the continued success of the program. Examples of beneficiary feedback for the MTM program are shown in table 2.
PerformRx has successfully demonstrated that our MTMP can significantly increase a health plan’s CMR completion rate, and consequently, its Star Rating, within one year of implementation. In addition to this, the positive feedback received from beneficiaries engaged in the program is indicative of beneficiary engagement in the program, which is vital to its continued success.
Email PerformRx today to learn how our MTM programs can help to improve your members’ health and well-being.
- Medication Therapy Management Program, CMS, https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/MTM.
- Medicare 2021 Part C & D Star Ratings Technical Notes, CMS, https://www.cms.gov/files/document/2021technotes20201001.pdf-0.