Presented by Jim Grant, MA Physician Practice Pharmacy QIOSC FMQAI Third Annual Medicare Conference Session 3.04 Medication Therapy Management Panel Presented by Jim Grant, MA Physician Practice Pharmacy QIOSC FMQAI

Objectives Introducing Quality Improvement Organizations QIO involvement with MTMS What does the future hold?

What is a Quality Improvement Organization? 40 organizations with CMS contracts for all 50 states and 3 territories Improve the quality of care provided to Medicare beneficiaries Beneficiary protection for quality of care issues Projects in hospitals, home health, nursing homes, physician practices and now pharmacy issues Each project cycle is 3 years The current cycle (8th Statement of Work) started 8/1/05 and goes through 7/31/08

What are the QIOs doing in regards to Medicare Part D? CMS views this period as experimental or formative work Each QIO could develop a project with a focus on improved prescribing, MTM, therapeutic monitoring, or electronic prescribing Some states formed consortiums to work on a common project Each project has a baseline measure period, an intervention phase and quality indicators to determine project impact

MTM Projects By definition in MMA MTM is to: Optimize therapeutic outcomes Reduce the risk of adverse events Reduce adverse drug interactions MTM projects need outcome metrics to assess the impact of the program

What are QIOs doing to assist with MTM? 26 states are working on MTM as an intervention to impact the care of beneficiaries with multiple chronic conditions, who are on multiple medications, and who will experience a medication cost greater than $4000 (in 2006) Some MTM programs are open to all members QIOs are looking at effectiveness of MTM in different settings, by different providers and through different means (face-to-face, telephone, mailings, web-based)

What are QIOs doing to assist with MTM? What works and what contributes to the success of the program Some quality indicators include: Clinical measures Member retention Comparison between different settings or venues for MTM Cost benefit analysis or return on investment - sustainability

What are QIOs doing to assist with MTM? Education (CME) for Pharmacists Materials to increase awareness in beneficiaries and providers Provider and member surveys Data analysis and reporting

What Does the Future Hold? Some of the National Drug Plans would prefer a national quality project Stakeholder meeting early 1st Q 2007 Project would be implemented in 9th SoW starting 8/2008 Attempt to reach some consensus on quality indicators for Prescription Drug arena

Medication Measures CMS, Pharmacy Quality Alliance, NCQA, AHRQ, SCRIPT ATLAS, CHARM, VALIANT, CARDS, TNT, HOPE Conformity to consensus clinical guidelines Other aspects of the medicating process need exploration

Medication Measures (Cont) Institute of Medicine Preventing Medication Errors: Quality Chasm Series Prescribing, Transcribing, Dispensing, Administration, and Monitoring for effect What happens in one setting can affect another Hospital  Home

Thank you!!! This is a work in progress. Questions or suggestions for additional content are welcome. We hope the presentation gives some fertile ground for developing concept papers into full project plans and stakeholder development.

Disclaimer: The material was prepared by FMQAI, the Medicare Quality Improvement Organization for Florida, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication# FL200607T3PP3E1410139