Maximizing Medication Therapy Management (MTM)

While MTM plans are required, maximizing them can yield a higher pay-off for health plans and their members.
Medication Therapy

Caring for the Medicare population can be particularly complex, especially with nearly 68 percent of Americans aged 65 and older managing multiple chronic conditions, according to the Centers for Disease Control and Prevention (CDC). Taking a comprehensive, whole-person care approach that centers on improving the health of this complex population is critical to the health of our nation’s seniors and to the success of our country’s Medicare plans. That is why Medication Therapy Management (MTM) programs are so important.

At the heart of MTM is a check and balance measure called a Comprehensive Medication Review (CMR) Completion Rate that ensures plans are appropriately supporting seniors by providing both the patient and the provider with actionable resources to better understand and manage their health, such as targeted medication reviews that address concerns about cost, identify gaps in therapy and provide guidance on adherence.

As benefit plans enter the home stretch of preparing 2021 benefit designs for bid submission, health plans should consider the following strategies within their MTM program to help them remain as competitive, keep customers, and enhance their Stars performance.

Leverage MTM to improve Star Ratings

The MTM CMR Star Rating measure tracks the completion of CMRs conducted by plans to ensure that they are appropriately reaching out to and engaging members. Industry performance of the MTM CMR Rating measure continues to improve year-over-year. In fact, the 2020 Star Ratings target for CMR completion is up 6 percent compared to 2019. Ensuring that plans are meeting or exceeding this threshold could be the push they need to tip the scale from one star rating to the next.

Meet members where they are

MTM is a member-centric program, and CMS wants to see plans, and will reward plans that increase their focus on the member experience and deliver the best care possible. They’re looking for plans that leverage established relationships, such as those with a retail pharmacist, to engage members in a more personalized manner.

Whether members want to be reached in the convenience of their homes via a phone call by a clinician, or through an established relationship with their pharmacist, MTM vendors should be able to target members through multiple channels. This engages them when and where they need care the most and can positively impact Star Rating measures.

Be flexible

Just as a member population is unique, so too are plans. Flexibility is key to building a program that aligns to plan priorities and meets MTM compliance guidelines outlined by CMS. Finding a strategic partner who can support goals and look for new opportunities to help drive desired results, like optimizing therapeutic outcomes or evolving the approach to achieving CMR rate goals, is crucial.

Whether plans are looking to increase performance, change the way their MTM plan engages with members, or are searching for a new strategic partner, now is the time to decide what is most valuable to a plan and start focusing on options that will help them best meet the health plan and member needs.

Account teams or Medicare Market Strategists can help assess every angle of MTM programs and uncover new ways for plans to be successful in the MTM space, like offering appropriate oversight, reporting and audit support, and a clear vision of the future of MTM. In 2021, let MTM programs do the work for health plans, not the other way around.


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