Strategies to Increase CMR Completion Rates in Medicare ...€¦ · Huet AL et al. Impact of passive and active promotional strategies on patient acceptance of medication therapy

Strategies to Increase CMR Completion Rates in Medicare MTM ProgramsErwin Jeong, Pharm.D., FCSHPClinical Operations Manager, Medicare MTM Program

Kaiser Permanente, Southern California

October 29, 2016

Disclosure Statement

Erwin Jeong, Pharm.D. declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

3 © 2011 KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

4 | © KAISER PERMANENTE 2010-2011. ALL RIGHTS RESERVED. October 18, 2016

24.0% 45.6%

PDP CMR Completion Rate

(CY2015)

MAPD CMR Completion Rate

(CY2015)


Learning Objectives

Summarize data requirements◦ For the Medicare Stars Medication Therapy

Management (MTM) Comprehensive Medication Review (CMR) Part D Measure

Increasing the number of CMRs◦ Describe methods Medicare Part D MTM programs

can use to increase the numbers of CMRs

6 © 2011 KAISER FOUNDATION HEALTH PLAN, INC. October 18, 2016

Requirements of a Medicare MTM Program

Optimizes therapeutic outcomes through improved medication use Reduces the risk of adverse events Developed in cooperation with licensed and practicing pharmacists and physiciansMay be furnished by pharmacists or other qualified providersMay distinguish between ambulatory and institutional settings

42 CFR §423.153(d)A Part D sponsor must have established a MTM program that:

CMS.gov Medicare-Prescription Drug Coverage Contracting-Medication Therapy Management. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/MTM.html (accessed 1/6/16)

https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/MTM.html


What is a CMR?

Interactive, person-to-person, or telehealth review

Review of all medications (prescription, OTC, herbal, dietary supplements, etc.)

CMS standardized written summary provided

CMS memo dated 4/7/15. Subject CY2016 Medication Therapy Management Program Guidance and Submission Instructions. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Memo-Contract-Year-2016-Medication-Therapy-Management-MTM-Program-Submission-v-040715.pdf (accessed 1/6/16)

https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Memo-Contract-Year-2016-Medication-Therapy-Management-MTM-Program-Submission-v-040715.pdf


MTM Program Completion Rate for CMR (D15)

Patients who had a pharmacist (or other health professional) help them understand and manage their medications

◦ Exclusion: beneficiaries in hospice any time during the reporting period

Weighting value: 1 (process measure)

CMS Medicare 2016 Part C&D Star Rating Technical Notes (updated 9/02/2015)

Number of beneficiaries who received a CMR during the MTM enrollment period

Number of beneficiaries 18yrs or older at the beginning of the reporting period who enrolled in the MTM program for at least 60 days

% CMR completion

*100=


MTM Measure Detail

CMS Medicare 2017 Part C&D Star Rating Technical Notes. First Plan Preview (updated 8/3/16)

CMR Completion Rate Trend


0%

5%

10%

15%

20%

25%

30%

35%

CY2012 CY2013 CY2014

Average of all programs (MAPD, PDP, Employer groups)


CMR Completion Rates

CY2012 CY2013* CY2014 CY2015

PDP 6.3% 10.3% 15.4% 24.0%

MAPD 16.1% 22.7% 30.9% 45.6%

Average 10.5% 15.5% 28.9%^

* Met specified targeting criteria (non-expansion)^ Calculated based on all plans with reported data

• CMS Medicare 2016 Part C&D Star Rating Technical Notes (updated 9/02/2015)• Analysis of Calendar Year 2013 Medicare Part D Reporting Requirements Data (Nov 2015). https://www.cms.gov/Medicare/Prescription-

Drug-Coverage/PrescriptionDrugCovContra/Downloads/2013-Part-D-Annual-Report_December-2015.pdf (accessed 12/30/15)• CMS.gov. Prescription Drug Coverage – General Information. Part C and D Performance Data. 2016 Part C and D Medicare Star Rating

Data (v10062015). https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html(accessed 1/6/16)

• CMS Medicare 2017 Part C&D Star Rating Technical Notes – Draft (updated 09/06/2016)

https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/2013-Part-D-Annual-Report_December-2015.pdf

https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html


Medicare Star Cut PointsMAPD Plans

2 Stars1 Star 3 Stars 5 Stars4 Stars

CY2015

CY2014

CMS Medicare 2016 Part C&D Star Rating Technical Notes (updated 9/02/2015)CMS Medicare 2017 Part C&D Star Rating Technical Notes – Draft (updated 09/06/2016)

< 13.6% 13.6 to 36.1% 36.2 to 48.5% 48.6 to 75.9% >= 76.0%

< 33.2% 33.2 to 47.7% 47.8 to 58% 58.1 to 76.7% >= 76.8%


Medicare Star Cut PointsPDP Plans

CMS Medicare 2016 Part C&D Star Rating Technical Notes (updated 9/02/2015)CMS Medicare 2017 Part C&D Star Rating Technical Notes – Draft (updated 09/06/2016)

2 Stars1 Star 3 Stars 5 Stars4 Stars

CY2015

CY2014 < 8.5% 8.5 to 16.5% 16.6 to 27.1% 27.2 to 36.6% >= 36.7%

< 12.6% 12.6 to 20.2% 20.3 to 33.8% 33.9 to 51.5% >= 51.6%

CY2014 MTM CMR Completion Ratings


1 star 2 stars 3 stars 4 stars 5 starsMAPD 61 205 84 36 11PDP 22 10 14 6 4

0

50

100

150

200

250

Num

ber o

f pla

ns

MTM Star distribution CY2014

MAPD n=397PDP n=56

CMS.gov. Prescription Drug Coverage – General Information. Part C and D Performance Data. 2016 Part C and D Medicare Star Rating Data (v10062015). https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html (accessed 1/6/16)

MAPD avg 2.3

PDP avg 2.3


Top MAPD plans in CY2014 (plans with data n=392)

Contract Name Parent Organization D15: MTM Program Completion Rate for CMR

HEALTHSPRING OF FLORIDA CIGNA 90.7%

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. UnitedHealth Group, Inc. 90.0%

KAISER FNDN HP OF THE MID-ATLANTIC STS Kaiser Foundation Health Plan, Inc. 88.6%

FLORIDA HEALTH CARE PLAN, INC. Guidewell Mutual Holding Corporation 86.8%

KAISER FOUNDATION HP OF GA, INC. Kaiser Foundation Health Plan, Inc. 85.1%

KAISER FOUNDATION HP, INC. (CA) Kaiser Foundation Health Plan, Inc. 83.6%

CONSTELLATION HEALTH, LLC. Constellation Health, LLC. 81.0%

ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION Rocky Mountain HMO, Inc. 76.6%

ALIGNMENT HEALTH PLAN Alignment Healthcare USA, LLC 76.6%

KS PLAN ADMINISTRATORS, LLC Kelsey-Seybold Medical Group, PLLC 76.1%

PRESBYTERIAN INSURANCE COMPANY, INC. Presbyterian Healthcare Services 76.0%




Top PDP plans in CY2014 (plans with data n=56)

Contract Name Parent Organization D15: MTM Program Completion Rate for CMR

REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH Cambia Health Solutions, Inc. 45.3%

QCC INSURANCE COMPANY Independence Health Group, Inc. 43.4%

USABLE MUTUAL INSURANCE COMPANY USAble Mutual Insurance Company 40.3%

ASURIS NORTHWEST HEALTH Cambia Health Solutions, Inc. 36.7%





Coordination

Previous patients

Outreach

Labor

Goals

Leadership support

CMRsMethods to

Methods to Increase CMR Rates

Commitment from upper leadership of the importance of the measure


Leadership support

Goals

Define attainable CMR completion rate targets based on past performance

Methods to Increase CMR Rates (cont’d)

Technicians or support staff: outreaching, scheduling, providing reminders

Pharmacy students/residents

Dedicated time for pharmacists

Third party vendors─ MTM specific─ Disease state management


Labor resources


Welcome packet ◦ Contents: letter, phone number to call, response card/questionnaire◦ Educate patients on what a CMR is (website, flyers, etc.)◦ Incentives

Phone outreach on patients who would benefit from an intervention◦ Predictive analytics based on prescription and/or medical claims◦ Targeted populations─ Use of a Medication User Self Evaluation (MUSE) tool was associated with 2x odds of a patient

completing a CMR1


1Doucette WR et al. Stimulating Comprehensive Medication Reviews Among Medicare Part D Beneficiaries. AJMC 2015; 21:e372-e378

Outreach

Methods to Increase CMR Rates (cont’d)Using patient self-reported information (MUSE tool)2

◦ Predicators to obtain a CMR: worrying that medications will do more harm than good; number of pharmacies used; number of medications and conditions

◦ Patients that perceived their health to be poorer were more likely to have a CMR

No significant difference between active (phone, face-to-face) or passive (letter, bag stuffer) outreach for face-to-face appointments in community pharmacies of a grocery chain3

Automated voice response systems

Letters to patients with specific opportunity◦ e.g. drug copay savings (change from brand to generic)


2Farris KB et al. Effect of Clinical and Attitudinal Characteristics on Obtaining Comprehensive Medication Reviews. JMCP 2016; 22(4):388-953Huet AL et al. Impact of passive and active promotional strategies on patient acceptance of medication therapy management services. JAPhA 2015; 55:178-181


Patients who had a CMR in prior years are more familiar with the programFactors that positively influenced patients to undergo a CMR in those who had one in the past4: ◦ Positive experience with a prior CMR and the perception that it was important to

their health◦ Physician support

Patients who were offered and completed a CMR in the past had a higher CMR completion rate vs other outreach models5


4Doucette WR et al. Factors affecting Medicare Part D beneficiaries’ decision to receive comprehensive medication reviews. JAPhA 2013; 53:482-875Miller DE et al. Evaluation of Comprehensive Medication Review Completion Rates Using 3 Patient Outreach Models. JMCP 2016; 22(7):796-800

Previous enrolled patients


Consider scheduling CMRs prior to annual wellness appointments with physicians


Coordination and collaboration

Ultimate goalso Patient safety and o Optimizing the therapeutic outcomes of the patient’s medications

Focus on Star-quality measures◦ Adherence: Statin, Diabetes, Hypertension◦ High Risk Medications in the Elderly◦ Others


…the Outcomes

Kaiser Permanente California Medicare MTM


60.2%67.3%

76.5% 77.6% 80.2% 81.4%

2010 2011 2012 2013 2014 2015

CMR completion rates by program year

KP California Medicare MTM Clinical Outcomes

Adherence


PDC >= 80% 2014 2015

Statins 85% 87%

Oral hypoglycemics 80% 81%

RAS antagonists 86% 87%

2010 2011 2012 2013 2014 2015High-risk

medications in theelderly

20% 14% 9% 11% 9% 8%

0%

5%

10%

15%

20%

25%

High-risk medications in the elderly


SummaryCMR Completion Rate◦ CMS identified process measure◦ Measures the Performance/“Quality” of Medicare

MTM Programs

MTM Programs using multiple methods to increase CMR Completion Rates◦ Leadership Support◦ Setting Attainable Goals◦ Dedicated Resources◦ Outreach◦ Targeting Previously Enrolled Patients◦ Coordination & Collaboration with Others


Thank You!

Contact information: [email protected]

1. CMS defines a comprehensive medication review (CMR) as:a. Interactiveb. Reconciliation of all medications (prescription, OTC, herbal, dietary supplements)c. Standardized written summary is providedd. All of the above

2. True or False. A method of outreach involves sending the patient a letter with a specific opportunity to improve medication therapy

Self Assessment Questions

1. Write down the session code. Space has been provided in the daily program-at-a-glance sections of your program book.

2. To claim credit: Go to www.cshp.org/cpe before December 1, 2016.

Session Code: 587419

0126-0000-16-659-L01-P/T

Documents

Strategies to Increase CMR Completion Rates in Medicare ...€¦ · Huet AL et al. Impact of passive and active promotional strategies on patient acceptance of medication therapy