PharmMD supports the Center for Medicare and Medicaid Services (CMS) Final Call Letter for 2013, released yesterday, April 2.
The Call Letter provides guidance to plan sponsors on how to deliver programs within Medicare Part C and D. PharmMD is supportive of CMS' direction with the Call Letter specific to Medication Therapy Management (MTM) programs and is able to provide Plan Sponsors with the abilities to excel at the delivery of MTM programs and Plan Ratings within the guidance provided by CMS.
"CMS clearly indicates that MTM programs should be enhanced, and services should be designed and delivered with benefit to beneficiary in mind," said Brad Tice, Chief Clinical Officer of PharmMD.
PharmMD has the abilities to help design MTM program submissions and deliver and report on a program to meet and exceed CMS expectations while aligning program and corporate goals with MTM programs and Star Ratings. PharmMD has an end-to-end solution that can also be customized from an in-house solution to a fully out-sourced model, providing plan sponsors with the desired flexibility in the design and delivery of their programs.
Highlights of the Call Letter include:
- Inclusion of the Pharmacy Quality Alliance (PQA) measure
"Completion Rate for Comprehensive Medication Review (CMR) as a
display measure for 2013 and expected as a Plan Rating measure for
- Implication:Beneficiaries will see the Plan's Star Rating on the percent of MTM eligible beneficiaries receiving the person-to-person, interactive CMR. Plan Sponsors will now be focused on increasing performance in this category. The industry average is believed to be approximately 5% with PharmMD able to target specific levels and achieve and report delivery rates in excess of 40% based on 2010 results.
- Increased focus on eligibility – CMS has expected more than
10-13% of members will be eligible for MTM and is analyzing disease
"combinations plans require for targeted enrollment and prevalence in
the Medicare population."
- Implication: CMS stated in its 2010 MTM Fact Sheet that they expected 25% of Medicare beneficiaries to be eligible for MTM. Plans will need to address eligibility criteria when the submission guidance is released later this month to increase eligibility.
- Increased focus on targeting – as outlined in the Advanced
Notice Call Letter, members must be targeted for a CMR offer within 60
days of identification. CMS also emphasizes outreach using multiple
and non-passive methods.
- Implication: Plans must perform more outreach and perform outreach earlier in the year.
- Standardized format required for action plan and written summary will
be implemented as expected for January 1, 2013. This format will drive
service delivery of the Comprehensive Medication Reviews.
- Implication: The standardized format will drive service delivery expectations when performing CMRs with beneficiaries. It is also likely to increase costs to deliver and mail the documents.
- Plan Ratings: Several changes to Plan Ratings are occurring
that are of note as well
- The High-Risk Medication list will be adjusted based on PQA, NCQA, and the American Geriatrics' Society's update to the Beers List of inappropriate medications in the elderly. The rating will also remain weighted by a factor of 3.
- The Call Center rating has more specificity when defining successful contact.
These are just a few of the highlights. PharmMD looks forward to being a resource to existing and new clients during this period of MTM program submission and throughout the year to ensure optimal delivery and performance on plan sponsors' MTM programs and Star Ratings.
PharmMD is the quality leader in Medication Therapy Management Solutions. Based in Brentwood, Tenn., PharmMD works with employers and health plans to prevent medication related health problems through the application of the best pharmacist and physician knowledge using their proprietary MTM software. Founded in 2006, PharmMD improves coordination and communication among physicians, pharmacists, payers and patients by analyzing pharmacy and medical claims information and clinical decision making. Because PharmMD focuses exclusively on MTM, the company is able to analyze both aggregate and patient-specific data to identify trends and conflicts to positively impact patient health and contain costs.
More information at: www.pharmmd.com.
Lauren Fulton, 615-254-0575