PROGRAM DESCRIPTION\u00a0<\/strong>
\nThe U.S. Centers for Medicare and Medicaid Services (CMS) requires Medicare Part D sponsors to have Medication Therapy Management Programs (MTMP) to ensure that qualified beneficiaries use safe and appropriate medications for their medical conditions. Under CMS guidelines, beneficiaries who qualify for MTMP include patients with multiple chronic diseases, those taking various Part D drugs, and beneficiaries incurring an annual drug cost that exceeds a predetermined amount.<\/p>\n
One required part of MTMPs is a comprehensive medication review (CMR). CMS defines a CMR as \u201can interactive, person-to-person, or telehealth medication review and consultation of a beneficiary\u2019s medications \u2026 by a pharmacist or qualified provider.\u201d CMRs are required annually and \u201cintended to aid in assessing medication therapy and optimizing patient outcomes.\u201d<\/p>\n
CMS first began considering CMR completion rate as an official Star Ratings measure in 2016 and announced the Star Rating cut points, which are listed in Table 1.<\/p>\n\n\n\n\n\n\n Once the CMR completion rate display measure took effect, one Part D Health Plan* collaborated with Abarca to re-engineer its MTM Program, which previously was performing at two stars. To assist this plan, Abarca launched an innovative approach that combined technology, analytics capabilities, and a clinical team of epidemiologists, nurses, and pharmacists to develop a comprehensive MTM solution aimed at improving the CMR Completion Rate, the patient and prescriber experience, and quality of the program.<\/p>\n From the start, this program was unique in that it was seamlessly integrated into Abarca\u2019s proprietary PBM platform. This enabled analytics, prescriber outreach, and quality assurance programs to be carefully synchronized to deliver targeted interventions around MTM outreach and adherence in a standardized and reproducible manner. It also allowed Abarca to respond quickly to client requests and regulatory requirements.<\/p>\n The initiative included the following components:<\/p>\n Abarca\u2019s approach to improving the CMR quality and completion rate focused on three major components:<\/p>\n During this assessment, the pharmacist or qualified personnel identified medication-related problems and provided a summary of their findings with recommendations to the beneficiary and prescribing physician(s).<\/p>\n ACHIEVED OUTCOMES<\/strong><\/p>\n In less than two years, the new MTM Program allowed Abarca and the Part D Health Plan to improve the CMR display measure from three stars to five stars. The Plan reached CMR completion rates of 84% and 88% for both plans in 2016. These results contributed to helping the plan achieve an overall 5-star rating from CMS for Part-D.<\/p>\n LESSONS LEARNED<\/strong><\/p>\n Abarca learned many lessons along the way and has used that knowledge to improve the program and CMR completion rates. The following are the top five noteworthy lessons learned:<\/p>\n This quality improvement initiative and program may be used as a model of care for other clinical interventions related to URAC, HEDIS, stars, and quality measures.<\/p>\n Download the case study.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Type<\/span><\/th>\n 1 Star<\/span><\/th>\n 2 Stars<\/span><\/th>\n 3 Stars<\/span><\/th>\n 4 Stars<\/span><\/th>\n 5 Stars<\/span><\/th>\n<\/tr>\n<\/thead>\n Medicare Advantage Prescription Drug Plan (MA-PD)<\/td>\n <33%<\/td>\n \u226533% to <51%<\/td>\n \u226551% to <59%<\/td>\n \u226559% to <75%<\/td>\n \u226575%<\/td>\n<\/tr>\n Prescription Drug Plan (PDP)<\/td>\n <17%<\/td>\n \u226517% to <31%<\/td>\n \u226531% to <39%<\/td>\n \u226539% to <53%<\/td>\n \u226553%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n
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