Improve star ratings by focusing on MTM

November 15, 2015

CMS recently released 2016 Star Rating data, and the news is not good for many Medicare plans, particularly for standalone Part D prescription drug plans.

The Centers for Medicare and Medicaid Services (CMS) recently released 2016 Star Rating data, and the news is not good for many Medicare plans, particularly for standalone Part D prescription drug plans (PDPs). PDP plan performance has faltered since last year. While average overall Star Ratings increased from 3.92 to 4.03 for Medicare Advantage Prescription Drug plans, the average rating for PDP plans decreased from 3.75 to 3.40.

So why are Medicare plans continuing to struggle?

This year, CMS added a new Part D star measure, which many plans across the board struggled with: the Medication Therapy Management (MTM) Program Completion Rate for a Comprehensive Medication Review (CMR). MTM programs help ensure that prescribed medications are effective at optimizing patient outcomes and avoiding unnecessary costs. Medicare Advantage and PDP plans average a 2.3 rating for the CMR completion rate. This is the lowest overall average rating of the 15 Part D star measures. To obtain a 4 rating for this measure, Medicare Advantage plans will need to increase their average CMR completion rate from 31% to 48.6%, and PDP plans will need to increase from 16% to 27.2%.

GreenwoodHigher ratings can be achieved when an MTM program balances quality and quantity for plan members. However, effective MTM programs can take years to implement. Enrollees eligible for MTM typically have a combination of chronic diseases, take multiple drugs, and have significant drug costs. Programs that are most effective emphasize quality patient engagement strategies to ensure that medications are being adhered to and managed effectively. This simply is not achievable without a significant investment of time and resources.

Many plans choose to use outside personnel and programs, which often combine a customer service contact center with clinical pharmacy expertise to address and enhance specific measures that can be difficult to remedy in-house. For example, strategies that focus on patient engagement and optimized recommendations can lead to CMR completion rates that exceed the industry standard.

Nearly 90% of plans use outside personnel to perform MTM, and 70% contract with an MTM vendor to provide this service. A successful program focuses on obtaining the right contact information and promotes a patient-centric approach to improve reach rates and keep patients engaged throughout the MTM encounter. Personal telephonic interaction using motivational interviewing techniques can improve engagement and employing a team of pharmacists to assess medication regimens and develop optimized clinical medication and lifestyle recommendations can enhance a program’s success.

Utilizing a team of clinical pharmacists to provide MTM can also enhance Star Rating measures that address medication adherence. MTM programs with a strong clinical structure can influence these measures by engaging both patients and prescribers with meaningful drug therapy interventions-ultimately improving outcomes for each patient.

Medicare plans cannot underestimate the importance of the member experience. Every measure is, in large or small ways, influenced by the member experience. If members are not engaged, medication therapies will falter. If members are not familiar with their benefits, health outcomes could decline. If members do not feel their plan is working for them, they will not utilize the benefits available to them-or they may choose to leave the plan.

Bonnie Greenwood,PharmD, BCPS, is clinical program director of the University of Massachusetts Medical School’s Clinical Pharmacy Services, which works with UHealthSolutions, a UMass Medical School business affiliate, to enhance the member experience and improve plans’ Star Ratings.