Pharmacies

CMR Completion Measure Highlights 2016 Star Ratings Update

0 Comments

New metric indicates a largely untapped opportunity to provide MTM services.

June 22, 2016

The Centers for Medicare and Medicaid Services (CMS) implemented Star Measures to drive improvement in Medicare quality and provide beneficiaries an opportunity to select a health plan that best meets their needs. The published Star Ratings measure quality in Medicare Advantage (MA) and Prescription Drug Plans (PDPs), and beneficiaries are enrolling in ever-larger numbers to higher performing plans.1

In CMS' own words, the ratings support the agency's efforts "to improve the level of accountability for the care provided by physicians, hospitals and other providers" and to drive improvements in Medicare quality.2

CMS calculates overall ratings on a five-star basis through measures across several domains of performance. Part D domains include Drug Plan Customer Service, Member Complaints/ Electing to Leave the Plan, Member Experience and Patient Safety.3 Fifteen measures apply to Part D plans for 2016, with those ratings based on 2014 claims data. The medication use measures that pharmacies can greatly impact are part of the Patient Safety domain.

New to the mix for 2016 scores - and highly relevant to pharmacies participating in Part D plans - is a new process measure: Medication Therapy Management (MTM) Program Completion Rate for Comprehensive Medication Reviews (CMRs). This new measure carries a weight of 1 (as compared to medication use metrics, which receive a weighting of 3). Nonetheless, the MTM process measure plays a part in determining how highly a plan will be rated on continuous quality improvement in patient care and outcomes.

How the measure works, and why it's important
The MTM Program Completion Rate for CMR applies to health plan members who had a pharmacist (or other health professional) help them understand and manage their medications. The measure indicates how many members in an MTM program had an assessment of their medications from the plan during a reporting period. (Beneficiaries must be 18 years or older as of the beginning of the reporting period. They also must have been enrolled in the MTM program for at least 60 days during the reporting period.)

The assessment, according to CMS Technical Notes, "includes a discussion between the member and a pharmacist ... about all of the member's medications. The member also receives a written summary of the discussion, including an action plan that recommends what the member can do to better understand and use his or her medications."4 The CMS website (www.cms.gov) provides multiple examples of the standard written format for the CMR summary.

Independent pharmacies should view the MTM process as a direct way to improve patient care. High performance in this area depends on factors such as having an effective medication adherence program in place, as well as a standard for one-on-one communications to help patients understand their medications and why it is important to be adherent. In short, think about MTM as a way to implement those critical patient interactions that help drive increased adherence and uncover additional patient care opportunities.

Room for improvement
The average CMR completion rates for 2016 (based on 2014 data) were 30.9% for MA-PDs and 15.4% for PDPs, within the cut points for a 2-star measure rating for both types of plans.5 Looking at the inverse of those percentages, it's readily apparent that a large number of patients with chronic conditions did not receive the CMR benefit.

This gap represents a substantial opportunity for pharmacists, who already see patients on a regular basis while filling prescriptions. Pharmacists are in the best position to answer patient questions via the MTM process. However, MTM must be effectively integrated into the pharmacy's workflow.

The following recommendations will help pharmacies meet that challenge:

  • Recognize the full breadth of the CMR opportunity. Pharmacies should know how many CMRs could be available to them. Pharmacies should also keep in mind that if they aren't completing the CMR cases for their patients, those cases may be completed by another health care professional to drive overall improvement in CMR completion rate performance. Health plans often partner with an MTM vendor to reach across a large number of pharmacies. As such, pharmacies should be familiar with available MTM platforms and may request training on how to access data on each of them directly from the MTM platform vendor.
  • Establish a systematic appointment-based model. Pharmacies should carve out time in their weekly schedule for CMR patients in either of two ways: Setting aside dedicated blocks for MTM services or concentrating on workflow efficiencies in their regular routine to open up more opportunities for CMRs. Implementing a medication synchronization program may help a pharmacy schedule staff and prescription volume more efficiently, which, in turn, will allow time to complete MTM interactions.
  • Leverage the burden across staff. The sole responsibility of conducting CMRs shouldn't fall on the pharmacist's shoulders. Engaging staff, first by communicating why quality outcomes are important, and then by enlisting their help in scheduling patients, is critical.
  • Build on the trust factor. In one regard, the CMR completion rate documents how often a pharmacy performs clinical services. But there's much more to it on a personal level: The MTM program enables pharmacies to meet with patients one-on-one and make them more comfortable with their condition and how to take their medication most effectively. For instance, a pharmacy may discover through the course of CMR that the patient regularly takes an over-the-counter remedy - information that wouldn't necessarily come to light through standard consultation during a medication pick-up. That type of engagement contributes to patient trust, a key aspect that sets community pharmacies apart.

Utilizing pharmacy expertise
Stakeholders in the Star Ratings process have recognized the CMR completion rate as an essential component in helping plan members understand and manage their medications. Calling on their extensive training, clinical knowledge and experience, pharmacists are uniquely prepared to demystify that process - now and for years to come.

Approximately 65% of Medicare Advantage enrollees have selected plans rated with four or more stars for 2016.6 What's more, forecasts call for Medicare enrollment to increase at an average annual rate of 3.3% over the next 10 years and to reach 80.9 million in 2022.7

Think of these new enrollees as patients, often with chronic conditions, who will need a trusted advisor to help them with their care and understanding their medications.

1. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-09-29-2.html
2. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/2016-Part-C-and-D-Medicare-Star-Ratings-Data-v04-07-2016-.zip
3. http://pqaalliance.org/measures/cms.aspx 
4. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html
5. Ibid 1. 
6. http://pqaalliance.org/measures/cms.aspx
7. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Downloads/medicaid-actuarial-report-2013.pdf
0 Comments

Sign in or register to leave a comment