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A new Star Ratings measure makes case completion a high priority

Pharmacies that don’t make completing comprehensive medication reviews (CMRs) a priority could soon find themselves out of preferred networks.

In 2016, the Centers for Medicare and Medicaid Services (CMS) will include CMR completion rates in its Star Ratings for health plans, basing those 2016 ratings on 2014 data. (See “CMS Releases Advance Notice of Changes for Calendar Year 2016.”)

The opportunity for improvement in medication therapy management (MTM) is substantial. In 2012, less than half of the Medicare Part D beneficiaries eligible for MTM received those benefits, according to a study by Avalere Health.1

“Every independent pharmacy should be offering medication synchronization for key patient populations and completing the targeted MTM interventions that are available through platforms like Mirixa, Outcomes, Socrates and others,” says Health Mart’s chief pharmacist, Tony Willoughby. (See “Laying the Groundwork with Medication Synchronization” )

During McKesson’s ideaShare 2015 in San Diego last month, Health Mart president Steve Courtman told pharmacy owners and staff, “Your focus on MTM case execution is paying off.”

“In 2014, Health Mart stores were hard at work executing Mirixa MTM cases,” Courtman said. “At our peak, we reached 70% of patients, compared to 38% by chains. The personal relationships you have with your patients help you have effective conversations, and these result in best-in-class MTM performance.” (Read about one of the most successful pharmacies for completing MTM in “Be a Top-Performing Pharmacy on Star Ratings Measures: Invest in Relationships with Physicians and Patients.”)

Multiple Benefits for Pharmacy

“MTM is not just about reimbursement,” Hashim Zaibak, owner of six Hayat Pharmacy locations in Milwaukee, Wisconsin, told pharmacy owners at another ideaShare session. Through MTM, he said, a pharmacy can:

  • Improve patient outcomes
  • Reduce healthcare costs
  • Win new patients
  • Suggest additional services
  • Prove its value to payers

Hayat Pharmacy is so successful at MTM that a Medicare Advantage plan is both reimbursing the pharmacy for its MTM services and also referring patients there.

Through MTM, a pharmacy also can improve other medication-related performance measures, including adherence, gaps in therapy and high-risk medications in the elderly.

Medication Therapy Management 101

Integrate MTM in the Workflow

Offering medication synchronization frees up staff time for conducting MTM, Zaibak said, and “almost every MTM patient is a candidate for medication synchronization.”

Another key to creating time for MTM is using technicians effectively. A pharmacy can:

  • Train technicians to identify MTM candidates.
  • Schedule a technician to monitor MTM portals daily.
  • Dedicate a technician to schedule MTM appointments, calling patients and telling them how to prepare for the meeting, including what to bring and how much time it will take.
  • Assign technicians to assist with documentation and billing.

Health Mart’s new “Medication Therapy Management 101” guide explains how to complete targeted interventions and CMRs, and it flags actions where pharmacies can improve efficiencies by using their technicians.

What CMS Requires

CMS requires payers to offer a minimum level of MTM services to each Medicare Part D beneficiary, including an annual comprehensive medication review (CMR) with written summaries in CMS’ standard format.

A CMR consultation must review medications, including prescriptions, over-the-counter medications, herbal therapies and dietary supplements. CMS suggests looking back at least six months. The CMR documentation must include:

  • A Cover Letter reminding the beneficiary of what was discussed during the CMR and describing how to use the other two documents.
  • A Medication Action Plan detailing what the beneficiary needs to do and leaving a place to record notes.
  • A Personal Medication List including what medications are used, why each is used and the prescriber.

CMS also requires payers to provide quarterly targeted medication reviews with follow-up interventions to patients when necessary.

Health Mart’s new “Medication Therapy Management 101” guide includes detailed advice for handling both CMRs and targeted interventions, along with tips from high-performing pharmacies. Download the guide book »

 

1 “MTM Services Underused in Part D Drug Plans,” Pharmacy Times, Sept. 8, 2014. LINK