Download Journal of American Pharmacists Association, January/February 2009

Medication Therapy Management: Methods to Increase Comprehensive Medication Review Participation
Harrell T, RPh, Diaz M, PharmD Candidate, Ortega Y, PharmD Candidate
The University of Arizona, College of Pharmacy, Medication Management Center, Tucson, Arizona
STUDY DESIGN AND OBJECTIVE
BACKGROUND
The Centers for Medicare and Medicaid Services (CMS) require
health care plans to provide Medication Therapy Management
Programs (MTMPs) to Part D beneficiaries. Current CMS guidelines
require Part D sponsors to offer a Comprehensive Medication Review
(CMR) to each beneficiary participating in an MTMP. CMS has
recently adopted the Pharmacy Quality Alliance (PQA) MTM
Completion Rate as a performance metric by which program
sponsors will be evaluated. Beginning with calendar year 2013,
health plans’ MTM CMR Completion Rate will be displayed on the
CMS website using 2011 data. In 2014, the MTM CMR Completion
Rate will be a STAR metric using 2012 data.
Study Design
The Medication Management Center (MMC), located in The College
of Pharmacy at The University of Arizona, is an innovative center
providing telephone-based medication therapy management services
to beneficiaries of contracted Medicare Part D Plans. At the MMC,
highly trained pharmacists work directly with patients, providers, and
pharmacies to optimize medication therapies while reducing risk of
adverse events. The services aim to increase the quality of healthcare
and help reduce healthcare costs.
Study Objective
2010 process
• Retrospective database analysis
• Assessed CMR completion rates for 2010 and 2011
• Data included number of eligible MTMP beneficiaries who were
LIMITATIONS
PROCESS FOR CMR PARTICIPATION
Changes in 2011
In 2011, a greater focus was placed on CMR
participation rates. Since few members
requested CMRs from introductory mailings, the
following additions were made to the workflow:
In 2010, the MMC process focused on the resolution
of potential drug-related problems. Weekly TMRs
were performed to identify those members requiring
intervention such as a brief telephone conversation.
The general workflow follows:
offered a CMR and number of completed CMRs
• Comparison included only CMS contracts that MMC provided MTM
services for in both 2010 and 2011
• To determine the effect a process change had on the CMR
•Introductory letters were mailed to qualifying
beneficiaries
•A CMR appointment form with return envelope
was added to the introductory letters
•Introductory letters included an offer for a CMR
and provided one method to schedule a CMR
appointment:
• Toll-free number for the Medication Management
•Outbound TMR calls included a secondary offer
for a CMR
•When TMR calls were made to discuss potential
drug related problems, the caller would offer to
complete a CMR during the call
Center (MMC)
•CMR appointment consisted of 30 to 45 minute
phone call with a pharmacist
participation rate at the MMC
• To determine best practices for improving the rate of MTMP
MTM SERVICES
Comprehensive Medication Review
Targeted Medication Review
CMS defines a CMR as a review of a beneficiary’s medications, including
prescription, over-the-counter medications, herbal therapies and dietary
supplements, that is intended to aid in assessing medications therapy and
optimizing patient outcomes. A CMR must be completed as an interactive
person-to-person consultation with the eligible beneficiary. It must also
provide the beneficiary with an individualized written summary.1
CMS defines a TMR as a review that assesses medication use,
monitors whether any unresolved issues need attention, new drug
therapy problems have arisen, or if the beneficiary has
experienced a transition in care. Follow-up interventions are
provided as necessary. CMS requires targeted medication reviews
(TMR) to be performed at least quarterly.1
Pharmacy
Claims
Periodic
claims feed
from PBM or
health plan
MMC
TMR
Claims review
to identify
members
requiring
intervention
MMC
TMR Call
2011 ONLY:
Secondary CMR
offer
To determine CMR rates, the total number of CMRs conducted and the total number of members offered a
CMR in 2010 and 2011 were found using data sets provided by the MMC. Participation percentage was
determined using the number of members offered a CMR in the denominator and the total CMRs completed
in the numerator.
200000
MMC
CMR
216264
150000
153560
100000
50000
Welcome
Letter
Primary CMR Offer in both 2010 and 2011
2010
2011
12000
7%
10000
6%
10636
8000
Members Offered a CMR
•The changes in process yielded a 3,365% increase in CMR
completion rates.
2010
2011
• In 2010, patient participation and response to a CMR offer letter
was low
6.93%
5%
2010
2011
4%
CONCLUSION
•Adding a secondary CMR offer in 2011 led to a marked increase
in member participation and CMR rates
3%
4000
• The results are clear that patients are more apt to consent to a
CMR if they are called for a specific medication related problem
2%
• Continue to convert TMR calls to CMRs whenever possible
2000
1%
6000
440
0
0
RESULTS AND DISCUSSION
•When looking at the CMR rate for 2010, one should consider that
the MMC’s focus was on resolution of drug-related problems and
TMRs.
OUTCOMES: 2010 vs. 2011 CMR PERCENTAGES
250000
• Data from certain CMS contracts were excluded due to
unavailable data files. We do not feel that this had an impact on
our results.
•The increase in CMR rates yields higher performance
measurements for prescription drug plans. The findings of this
study are expected to have a positive impact on encouraging other
programs to implement similar changes to increase their CMR rate,
which will result in improved quality of care and lower healthcare
costs.
•Weekly TMRs identified patients requiring a
brief phone conversation to address and resolve
a drug-related problem. This was the main
focus.
beneficiaries participating in a CMR
• The 2011 process was not implemented until the month of May.
Had the process been implemented beginning in January of 2011,
we would expect to see even higher CMR participation rates. The
MMC is projecting a greater participation rate for 2012 .
0%
CMRs Completed
0.20%
Participation Percentage
Reference:
MTM Fact Sheet 2011. CMS. June 30, 2011