4 thoughts on how CMS' MTM program is addressing America's medication adherence problem, from an MTM expert

CMS launched the Part D Enhanced Medication Therapy Management model Jan. 1 in five Part D regions nationwide to test the use of innovative medication therapy management programs to improve care quality and decrease costs.

Through the five-year model, CMS will assess whether offering Part D sponsors additional payment incentives and regulatory flexibilities can facilitate improvements in the MTM model to achieve better patient outcomes and reduce Medicare expenditures.

"The model is about rapidly testing and learning [what is effective]," according to Jessica Frank, PharmD, vice president of quality for OutcomesMTM, a Cardinal Health company based in West Des Moines, Iowa. Dr. Frank is well versed in the development of MTM-focused quality measures designed to optimize medication use and has served on various industry boards and panels on MTM, including the CMS MTM Technical Expert Panel, the National MTM Advisory Board and the Pharmacy Quality Alliance Quality Metrics Expert Panel.

Dr. Frank spoke with Becker's Hospital Review about the Enhanced MTM Model and its implications for the future of healthcare.

Note: Responses have been lightly edited for style and clarity.

Question: What does CMS hope to accomplish with the Enhanced MTM Model test?

Dr. Jessica Frank: The primary goal of the Enhanced MTM Model test is to innovate around various strategies for MTM service delivery — including targeting strategies, risk-stratification methods and healthcare interoperability initiatives — to drive potential medical savings. The ultimate objective for plan sponsors participating in the model is to achieve at least a 2 percent savings on medical spend.

Q: What kinds of services are included in EMTM programs?

JF: Services will vary by plan sponsor. So far, we've discovered services designed to manage and reduce medical utilization, such as emphasizing medication reconciliation following a hospital discharge, align the best. Proper adherence to medications is one of the primary reasons for hospital readmissions, so helping to ensure a patient's medication list is accurate following a hospital discharge is a very important component of the program. It's also important to place more focus on patients who are taking medications that, like insulin or warfarin, are commonly linked to adverse events or emergency room visits related to inappropriate medication management.

Identification and resolution of medication therapy problems has been a central component of MTM programs for years. This model test is allowing plan sponsors to focus more on targeted interventions that will help optimize medication use and ultimately drive medical savings.

Q: How are participating plans engaging MTM providers?

JF: Some plans are engaging community pharmacists to deliver MTM services in the model, an approach encouraged by the House Committee on Energy and Commerce subcommittee on health to fully realize the model's impact on patient health. Community pharmacists are often best positioned to conduct medication reconciliation and comprehensive medication reviews, which are covered services in some of the programs implemented so far, although it is not a required component of the model.

In addition, health plans are looking at how they can better engage physicians to coordinate care and identify patients who may benefit from MTM services. One possible engagement strategy is establishing a referral process for MTM services, so physicians can coordinate a patient's medication needs in these models. While this effort is still in the early stages, plans have been able to engage providers by working with community pharmacists to consult with physicians around specific medication related problems.

Q: How could learnings from this model impact other areas of healthcare?

JF: The model allows for flexibility in offering patient incentives such as beneficiary incentives for specific services, cost-share reduction or waived copays. Testing patient behaviors with various incentives, as well as communication mechanisms, within the model could help identify best practices in patient engagement that may be applied more broadly in the core MTM programs for Medicare Part D and in markets beyond Part D. Some of what we learn from this model could certainly expand to other areas of healthcare in terms of how we engage and empower patients to take an active role in their health.

The other area that will definitely impact and improve healthcare is related to the required reporting for this model. This is the first time the pharmacy industry has implemented SNOMED CT codes as a method for capturing clinical interventions – a common language already used by many EHR systems. So this model is building the foundation to create interoperability and allow for bidirectional communication between pharmacies, physicians and health plans.

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