MTM Performance & Impact On Star Ratings 2016 & Beyond - OutcomesMTM Overview

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1 MTM Performance & Impact On Star Ratings 2016 & Beyond - OutcomesMTM Overview

2 Today s Speaker Dan Rodriguez, RPh, BPharm Sr. Associate Network Performance OutcomesMTM

3 Learning Objectives - Define Medication Therapy Management (MTM) Services, including the CMR - Recognize the scope of quality metrics within the health care system - Explain 2016 CMS updates and potential future measures - Identify opportunities to impact your patients today in a way that can enhance the quality of their health and prepares your pharmacy to participate in future healthcare models 3

4 What is MTM? Distinct service or group of services that optimize therapeutic outcomes for individual patients * - Services designed to: - Enhance enrollee understanding - Increase enrollee adherence - Detect adverse drug events, and patterns of overuse and underuse of prescription medications Medication Therapy Management services are independent of, but can occur in conjunction with the provision of a medication product * *Bluml BM. Definition of medication therapy management: development of wide consensus. J Am Pharm Assoc. 2005;45:

5 MTM Examples - Selecting, initiating, modifying, or administering medication therapy - Cost efficacy management - Resolving drug therapy problems with prescribers - Improving adherence to prescribed medications - Monitoring/evaluating patient response - Reducing Adverse Drug Events - Providing education/training to patients - Formulating medication treatment plans - Comprehensive medication reviews 5

6 What is so important about MTM? - 800,000 deaths/year due to rx s - MMA of 2003 required MTM services with rx s - Access - Community Pharmacist influence - Medication experts (2nd most trusted) - Value - Forbes - Newest Member of your Personal Healthcare Team - Pharmacist MTM services reduced readmissions 86% - Landscape - Quality-based pharmacy networks (Plans, Stars) - Team-based Care (ACO s, PCMH s) - Provider Status (H.R. 592, S.314) 6

7 MTM Benefits - Opportunity for pharmacists to practice at top of our license - Demonstrate value of pharmacist-provided services to payors - Forbes on Pharmacists, Transitional Care - The Newest Member of Your Personal Healthcare Team - Pharmacist MTM services yielded 86% reduction in readmissions compared to the control group - Patients receiving MTM were 3 times more likely to remain out of the hospital after 60 days - Pharmacists are most accessible health care provider - Currently underutilized resource - Quality-based pharmacy networks - Plans beginning to use these measures to determine quality of services pharmacists are providing in community pharmacy setting - Establishing preferred networks based on how pharmacies impact relevant Star measures 7

8 Progression of MTM Services - Pharmacists' roles on the health care team are expanding Business Wire (04/09/2015) Pharmacists are increasingly playing a greater role in patient care, according to a new study from the Pharmacy Workforce Center (PWC). The group's latest National Pharmacist Workforce Survey found that pharmacists are performing more patient care activities in a variety of settings, and they are spending less time in the traditional dispensing role. In addition, the survey found that more women than men are working as actively practicing pharmacists and in management positions. "The National Pharmacist Workforce Survey has once again pinpointed important shifts in the pharmacist workforce and reveals valuable insight about how pharmacists spend their time," said Douglas J. Scheckelhoff, vice president of the Office of Practice Advancement at the American Society of Health- System Pharmacists and president of PWC. The survey revealed that 60% of pharmacists provided medication therapy management and 53% performed immunizations in 2014, up from just 13% and 15% a decade ago. Meanwhile, the percentage of time that full-time pharmacists spent on medication dispensing dropped to 49% last year from 55% in

9 CMS Star Ratings - Five-star rating system to grade health plans - Star ratings are basis for monitoring quality and performance of Medicare plans and tied to quality bonus payments - Ratings based on different input including: - Medical and drug plan data - Member surveys 9

10 Star Rating System Breakdown MA-PDs Star Rating Part C Summary Rating 5 Domain Ratings 37 Star Measure Ratings Overall Star Rating PDPs Star Rating Part D Summary Rating 4 Domain Ratings 18 Star Measure Ratings 10

11 MA-PD s vs PDP s - Medicare Advantage Plans (MA-PDs) - Part A, Part B and Part D - receive quality bonus payments and other benefits based on overall Star rating for Quality and Performance measures - Prescription Drug Plans (PDPs) - only receive a summary Star rating for Part D Quality and Performance measures - currently are not eligible for quality bonus payments - Enhanced MTM Model (2017 and beyond) - Will allow targeting of specific patient populations (Diabetes, CHF, asthma, COPD) - Prescribers and pharmacists to identify at-risk individuals - Will include prospective payments - Will include performance payments (including the patient) 11

12 Opportunities for Pharmacists Impact Within Part D Domains - Domain: 4 Drug Pricing and Patient Safety - Measure: D14 High Risk Medication - Measure: D15 Diabetes Treatment - Measure: D16 Part D Medication Adherence for Oral Diabetes Medications - Measure: D17 Part D Medication Adherence for Hypertension Medications (RAS Antagonists) - Measure: D18 Part D Medication Adherence for Cholesterol Medications (Statins) 12

13 2016 and beyond beyond. - Comprehensive Medication Review measure (added in 2016) - CMS adds this to the 2016 Star Ratings - Avg CMR Completion Rate in % CMS MAPD CMR thresholds - 5 Star - >76% - 4 Star % - 3 Star % - 2 Star % - 1 Star - <13.6% - High Risk Medications moved to Display Measure in Upcoming Measures Medication Reconciliation post discharge (Part C) Display Star Rating - Statin Therapy for pats with cardio dz Display Star Rating - Two Asthma measures (Part C) Display Star Rating - Statin use in persons with diabetes (Part D) Display Star Rating 13

14 Performance CMR Offer Rate 23% 18% - CMR Comp Rate 11% 64% - TIP Comp Rate 25% 12% - TIP Success Rate 22% 45% - >500,000 Star measure opportunities addressed - Impact on Star Ratings - OutcomesMTM specific clients - Continued improvement seen in 75-80% of measures for Clients before and after Outcomes Client status - CMR completion % should be a focus for

15 What can YOU do today? - Understand the Quality Measures that impact Plans Star Ratings - Especially those that overlap with Pharmacist scope of practice - Adherence - High Risk Meds - IMZs - Deliver Comprehensive Medication Reviews - Star Rating Process measure for 2016 and beyond - Hallmark service for Medication Reconciliation - Focus on Adherence improvement for your patients - Statins, RASA, oral diabetes meds - Med Synch and Auto Fill programs - OutcomesMTM Med Sync TIPs - Once/year, UHC Med Sync TIPs - $50 each 15

16 Thank You Please complete our survey: Next webinar: MTM and other Star Ratings Measures How is Your Pharmacy Doing (Mirixa Overview) Click here to register March 29, 2016 at 9pm EST Goodneighborpharmacyevents.com ThoughtSpot 2016 July MGM Grand, Las Vegas Thoughtspot2016.com 16 3/24/2016 CONFIDENTIAL

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