Connecting Patients, Providers and Pharmacists
PharmMD Drives Accelerated MTM
Program Performance for National PBM
MTM Background and Evolving Market Context
In 2016, health plans and Pharmacy Benefits Managers (PBMs) will
face increased challenges regarding their Comprehensive Medication
Review (CMR) completion rates with the onset of new CMS
requirements and incentives. CMS looks to enhance the 2016 Star
Ratings by incorporating Medication Therapy Management (MTM)
as a Star measure, judging plans by their ability to achieve
recommended CMR completion rate thresholds.
Health plans and PBMs anticipate being advised of these rate targets
in October of 2015, and many plans will task their MTM provider
to hit these targets in 2015 to assess their proficiency and scalability.
Foreseeing the direction CMS was taking, one PBM charged with
managing a significant portion of the MAPD and PDP population
nationwide began experimenting with an aggressive approach - a
year before measurement would begin.
Having established its 2014 target CMR completion rate at 25%,
this National PBM made a significant mid-year strategic adjustment
in July 2014; it requested that its MTM provider elevate the target
completion rate to 36%. Then, in October 2014, the PBM wanted
to strive even higher and adjusted the target to a 42% CMR
completion rate.
With just 17 weeks remaining in the 2014 calendar year, this
nationally recognized PBM wanted to nearly double its original
CMR Completion rate target. As the PBM’s MTM provider, the team
at PharmMD in Nashville, Tennessee was prepared to take on the
challenge with the right tools and the right people.
Dynamic, algorithm-based
patient data analysis
identiļ¬es deviations from
clinical best practices
pharmmd.com
•
RV E N TI
O
Physician targeted and
patient prioritized
ES
2014 CMR target completion rate 25%
Mid-year target CMR completion rate
adjustment from 25% to 36%
October 2014, target CMR completion rate
elevated to 42%
4th Quarter Push
•
•
17 weeks left in calendar year and PBM wanted
to nearly double original CMR completion rate
target
PharmMD’s StarMTM provided a performancebased partnership
StarMTM Implemented
•
PharmMD aligned internal processes to receive
direction from client management team
PharmMD has the ability to integrate MTM with
Star Ratings Outcomes Measures
CMR Goals Achieved
•
•
•
•
•
PharmMD completed nearly 68,000 CMRs for
PBM in 2014
Customized strategic management for over 80
individual contracts
All but 1 contract surpassed 25%
2/3 of the contracts surpassed 36%
1/2 of the contracts surpassed 42%
O L U TIO
N
N
TE
R
E
I
IN
ID
ON
PharmMD’s StarMTM provides the clinical resources, operational
processes and tailored technology vital for a guaranteed CMR
completion rate and true ROI. Their systematic and scalable
approach integrates the power of targeted clinical analytics to meet
regulatory requirements, accurately identify Drug Therapy Problems
(DTPs) and complete CMRs - all in a performance-based partnership.
I F I C AT
•
•
•
4th Quarter Push
NT
National PBM Background
Proof point =
claims based evidence
1
PharmMD Implements StarMTM Program
With the maturation of PharmMD’s analytics surrounding all of
their operational metrics, they allocated the resources efficiently
and effectively; moreover, the experience also allowed PharmMD
to bring more science to call list prioritization, patient engagement
specialist traction, pharmacist capacity/pace, and behavioral
economics of population responsiveness and call completion.
> 50%
PharmMD aligned all of our internal processes to receive direction
from the client management team, who has responsibility for
operational performance. This alignment brought call center
allocations and directives closer to the client as accountability
became tied directly to the account team.
PharmMD was able to make determinations about how much activity
was needed to support the targeted CMR completion levels.
Activity Needed
800000
PATIENTS IMPACTED BY
MEDICATION NON - ADHERENCE
HOW MANY AMERICANS ARE TAKING
PRESCRIPTION MEDICATIONS?
600000
400000
21.7%
48.5%
200000
take at least 3 Rx
take at least 1 Rx
4-Sep
4-Oct
4-Nov
4-Dec
10.6%
take at least 5 Rx
AMONG ADULTS 45+
PharmMD Achieves CMR Goals for PBM
PATIENTS AFFECTED BY AT LEAST
1 CHRONIC CONDITION REQUIRING
MEDICATION THERAPY :
About PharmMD
For Health Plans or self-insured Employers that want to measurably improve
member and employee health, PharmMD is the proven choice for pharmacy
quality solutions. Founded by healthcare and pharmacy innovators, PharmMD’s
outcomes-driven reporting, priority on personal touch, and scalable network
are backed by performance-based pricing that guarantees fast results for Part
D Star Rating improvement and the most effective Medication Therapy
Management. For more information go to www.pharmmd.com.
29%
take at least 5 Rx
2015
157 MILLION
PharmMD appreciated the opportunity to extend the reach of the
Client MTM program activities. Our decision support and
documentation technology, combined with the comparative
advantages that characterize our scheduling work-flows, gave us
the ability to maximize the outputs and outcomes from our clinical
pharmacists.
81%
take at least 1 Rx
137 MILLION
The result? PharmMD completed nearly 68,000 CMRs for the client
in 2014 with customized strategic management for over 80 individual
contracts. As of December 31, 2014, all but 1 contract reached the
25% CMR goal, 2/3 of the contracts surpassed the 36% CMR goal
and ½ of the contracts surpassed a 42% CMR goal.
2020
Sources:
http://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm
http://www.ncbi.nlm.nih.gov/pubmed/21295193
http://healthitanalytics.com/news/medication-non-adherence-bringsmillions-in-avoidable-costs
Connecting Patients, Providers and Pharmacists
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