FEATURED: Point of View
Brad Tice R.Ph., PharmD, MBA, FAPhA
Medication Therapy Management,
Healthcare leaders are being pushed hard across the board to lower costs while raising quality. Medication Therapy Management (MTM) has been hailed by many, including the federal government, as one way to accomplish this important goal, especially in Medicare Part D. In fact, the Center for Medicare & Medicaid Services (CMS) calls MTM a “cornerstone” of Part D’s future and a practice that will “serve as a model for achieving quality.”
So, then, why do only 1% of eligible Medicare Part D beneficiaries get MTM services today? And what must health insurance plans do to reap the MTM benefits in CMS’ Five-Star Quality Ratings System and other ways?
Today, only a small share of Medicare Part D beneficiaries receive MTM services because health plans identify only 10% of members as eligible and, of these, only 10% get a Comprehensive Medication Review (CMR). That means only 1% of Part D beneficiaries – 10% of 10%! – get this “cornerstone” benefit of Part D’s future. This large disconnect between health plans and CMS cannot last.
- Improve your reach. Reach members where they receive care. Partnerships with providers who see patients frequently – retail pharmacies and long-term care facilities, for example – are crucial for connecting to the high-risk Part D patients whom CMS wants to receive MTM services. While call centers and direct mail campaigns have a role, the general, one-size-fits-all campaigns are expensive and not very effective. Health plans must identify and target subgroups. Leveraging data to identify those members who can most effectively be reached and impacted to drive value, as well as where and how to reach those members, can truly drive value creation. In these precision efforts, scale, data depth and analytical sophistication are enormously valuable.
Read more about why Medication Therapy Management is needed today.