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Medication Therapy Management: Methods to Increase Comprehensive Medication Review Participation Harrell T, RPh, Diaz M, PharmD Candidate, Ortega Y, PharmD.

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Presentation on theme: "Medication Therapy Management: Methods to Increase Comprehensive Medication Review Participation Harrell T, RPh, Diaz M, PharmD Candidate, Ortega Y, PharmD."— Presentation transcript:

1 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 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. 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. RESULTS AND DISCUSSIONCONCLUSION OUTCOMES: 2010 vs CMR PERCENTAGES 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. STUDY DESIGN AND OBJECTIVE Study Design Retrospective database analysis Assessed CMR completion rates for 2010 and 2011 Data included number of eligible MTMP beneficiaries who were offered a CMR and number of completed CMRs Comparison included only CMS contracts that MMC provided MTM services for in both 2010 and 2011 Study Objective To determine the effect a process change had on the CMR participation rate at the MMC To determine best practices for improving the rate of MTMP beneficiaries participating in a CMR LIMITATIONS 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 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 changes in process yielded a 3,365% increase in CMR completion rates. 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. 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. In 2010, patient participation and response to a CMR offer letter was low Adding a secondary CMR offer in 2011 led to a marked increase in member participation and CMR rates The results are clear that patients are more apt to consent to a CMR if they are called for a specific medication related problem Continue to convert TMR calls to CMRs whenever possible PROCESS FOR CMR PARTICIPATION A CMR appointment form with return envelope was added to the introductory letters 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 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: Changes in process MTM SERVICES Comprehensive 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 Targeted Medication Review 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 Introductory letters were mailed to qualifying beneficiaries Introductory letters included an offer for a CMR and provided one method to schedule a CMR appointment: Toll-free number for the Medication Management Center (MMC) CMR appointment consisted of 30 to 45 minute phone call with a pharmacist Weekly TMRs identified patients requiring a brief phone conversation to address and resolve a drug-related problem. This was the main focus. 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: Periodic claims feed from PBM or health plan Pharmacy Claims Claims review to identify members requiring intervention MMC TMR 2011 ONLY: Secondary CMR offer MMC TMR Call MMC CMR Welcome Letter Primary CMR Offer in both 2010 and 2011 Reference: MTM Fact Sheet CMS. June 30, 2011


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