Q&A with Jessica Frank, VP of Quality, OutcomesMTM
In September 2015, the Center for Medicare and Medicaid Innovations (CMMI) announced a test of new payment models for MTM. Beginning in January, the Enhanced MTM Model will run from 2017-2021 for stand-alone prescription drug plans (PDPs) under the Medicare Part D program. In five Part D regions, selected plan sponsors will offer innovative MTM programs, aimed at improving the quality of care while also reducing costs.
Test whether providing Part D sponsors with additional payment incentives and regulatory flexibilities will engender enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures
Evaluate the proportion of beneficiaries affected and MTM programs’ impact on:
- Patient outcomes and satisfaction
- Plan expenditures, including plan bids, and other Medicare spending
- Overall marketplace
Q: What are the biggest trends to watch as plan sponsors implement under the model?
As plan sponsors test innovations in MTM models, they’ll learn and gain insight to inform their models in future years. Given the tight window for application submissions, I don’t anticipate significant innovation within the first year. However, as plans acquire experience with various approaches, I believe we’ll see great progress for plan sponsors in three key areas:
- Fine-tuning risk stratification methods to vary intensity of MTM services based on beneficiary-specific needs
- Further leveraging providers in their networks, both physicians and pharmacists, to drive optimal medication use
- Standardizing the codification of MTM encounter data across the industry, which should provide opportunities to benchmark models, drive best practices and improve outcomes tightly linked to medical spend
“We also believe that without participation of retail community pharmacists, the testing of enhanced MTM models will fall short of achieving the maximum potential in terms of positive outcomes and impact on beneficiary health.”
House Committee on Energy and Commerce Subcommittee on Health in a letter to Secretary of Health and Human Services, Sylvia Burwell
Q: What can plan sponsors do to support the success of community pharmacies in Enhanced Model programs?
Of course, they should include pharmacies in their program! Community pharmacists offer scale and accessibility unlike any other healthcare professional. Beyond that, access to additional information, such as diagnosis codes, labs and hospital discharge summaries, can aid pharmacists in providing optimal MTM services. Right now, available health information for a beneficiary is typically limited to prescription medication records at the pharmacy level. This may mean plan sponsors taking a greater role in facilitating communication between pharmacies, physicians and health systems, particularly by
supporting health information exchanges.
Q: What kinds of MTM services do you foresee aligning best with the goal of reducing Medicare expenditures?
MTM services that are designed to manage, and even reduce, medical utilization will align best. These services may include medication reconciliation post transitions of care, intense monitoring of patients taking medications commonly linked to adverse events and services focused on optimizing medication adherence. Of course, resolution of identified drug therapy problems through consultation with members and their prescribers will be key, just as it is in MTM programs today.