Last month, members of our team attended AMCP 2021 to engage in the industry discussion regarding the latest trends in managed care. Here are some of the issues they found the most impactful:
1. Advancements are being made in outcomes-based Medication Therapy Management (MTM) quality measures. Over the last year, immunization assessments for patients enrolled in MTM programs have become more important than ever. Currently, there are two draft MTM immunization measures that are being evaluated:
- Immunization Status Assessment: The percentage of individuals eligible for MTM services that received an immunization status assessment during the measurement year.
- Compliance Following Immunization Status Assessment: The percentage of individuals eligible for MTM services that follow the Advisory Committee on Immunization Practices (ACIP) recommended vaccines.
However, the success of these measures is dependent on standardizing MTM documentation and reporting. Existing data standards, such as SNOMED CT (Systematized Nomenclature of Medicine, Clinical Terms), can be used to accelerate the adoption of streamlined processes.
2. Pharmacists can play a key role in assisting actuaries with Medicare Part D bid preparation. At Abarca, we appreciate the critical role that pharmacists can play in healthcare. However, the industry is now recognizing the impact that they can have on assisting actuaries with Medicare Part D bid preparation.
Among other areas, pharmacists can help with trend analysis, including drug pipeline review, formulary selection and development, and competitive landscape review. They can also educate actuaries on upcoming specialty drug launches.
3. Member experience has an increasing impact on CMS Star Ratings. In May 2020, CMS doubled the weight of member experience in a plan’s Star Rating. These scores have a direct effect on member enrollment and retention.
Among other factors, member experience includes medication access and cost, as well as interaction with providers. Pharmacists, in particular, play a critical role in this metric under value-based payment models.
Abarca was founded to deliver a better experience in healthcare, and we support the industry’s increasing focus on this area. During COVID, and beyond, Abarca is committed to collaborating with our partners to provide the highest quality services for members and ensuring they can easily and reliably access their medications.
This blog was written by Luis B. Lizardo, Senior Pharmacist at Abarca.