1. 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

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

3. 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

4. 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

5. 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

6. 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)

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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# FL200607T3PP3E