PharmMD Drives Exceptional MTM Performance
CMR Completion Rate Achievements for Health Plans and Pharmacy Benefits Managers
Challenges
In 2016, Health Plans and Pharmacy Benefits Managers (PBMs)
will continue to face increased challenges regarding their
Comprehensive Medication Review (CMR) completion rates
in the wake of CMS requirements and incentives. CMS has
enhanced Star Ratings for the foreseeable future by
incorporating Medication Therapy Management (MTM) as a
Star measure, judging plans by their ability to achieve
recommended thresholds. In addition, and with the CMMI
proposed Enhanced MTM Pilot for PDP plans, the table is being
set to focus on health outcomes – driving MTM services
towards being the lever of pharmacy-driven population health.
RESULTS
Met and
EXCEEDED
all guaranteed
obligations for
MTM SERVICES
180,000
CMRs
completed in 2 years
Foreseeing the direction CMS is taking, many Health Plans and
PBMs charged their MTM provider with the task of increasing
their CMR completion rates. The historical CMR rates we have
seen previously range from 10% to 60% across the country,
with the consensus average falling anywhere from 19% - 23%
nationally. As recent as the fall of 2015, coinciding with the
release of the 2016 Draft Technical Notes, our plan partners
challenged us to double or triple our contracted CMR rates, a
challenge we gladly met.
Solutions
PharmMD’s StarMTMTM solution provides the clinical resources,
operational processes and tailored technology platform vital
for a guaranteed CMR completion rate and a true ROI. Our
systematic and scalable approach integrates the power of
targeted clinical analytics to meet regulatory requirements,
accurately identify Drug Therapy Problems (DTPs) and complete
quality CMRs - all in a performance-based partnership. With
over 10 years of experience in managing medication risk,
PharmMD possesses the necessary insights and capabilities
to project success and allocate the appropriate resources to
achieve and exceed contractual goals.
With the maturation of PharmMD’s analytics surrounding all of
our operational metrics, we allocated the resources efficiently
and effectively. Moreover, our experience also allows us to
bring more science to call list prioritization, patient engagement
specialist traction, pharmacist capacity/pace, and behavioral
economics of population responsiveness and call completion.
PharmMD aligns all of our internal processes to receive direction
from the client management team, who has responsibility for
PharmMD.com
All Customers
RENEWED
for 2016
x
Tripled Regional Duals Plan vendor’s prior CMR rate
in a 12 month period securing a
5 Star Rating on two S-Plans and 4 Stars on 3
H-Plans.
x
Doubled prior Regional Blues Plan vendor’s CMR rate
in a 10 month period securing a
5 Star Rating on the S-Plan, and two 4 Stars and
one 3 Star on the H-Plans.
x
Doubled prior year’s National PDP Plan CMR
output to obtain a mid
3 Star Rating
Provided end of year surge
support services for National
MAPD Plan and increased
average CMR completion rate
by 17.1% across 12 plans
(taking them from a 2 to a 4
Star on average).
2 Star
increase
operational performance. This alignment brought call center
allocations and directives closer to the client as accountability
became tied directly to the account team. As a result, PharmMD
was able to make determinations about how much activity was
needed to support the targeted CMR completion levels.
Key Takeaways
Results
PharmMD has completed nearly 180,000 CMRs over the past
two years with customized strategic management for over 124
individual contracts.
•CMS enhances 2016 Star Ratings by incorporating MTM as a
Star Measure.
•Health Plans and PBMs face
challenges regarding their CMR
completion rates.
•95% member satisfaction based
on 2014-2015 post CMR survey
In the 2015 Measurement period, our Plan & PBM partners relied
heavily on PharmMD’s ability to increase productivity through a
quality-driven program in order to meet new CMS Star Rating
thresholds. Many of our clients experienced leaps of 2 Star
year-over-year improvement, which in many cases doubled or
tripled a previous vendors performance.
•StarMTM provides the clinical
resources, operational processes
and tailored technology vital for a
guaranteed CMR completion rate
and true ROI.
Additionally, PharmMD’s ability to provide surge resources
enabled our Plan partners to add capacity to their own internal
teams through the use of PharmMD’s P3LinkTM MTM platform.
The result is a perfect example of an ideal partnership: technology,
resources, and performance-based alliance all resulting in
meaningful results that support improved health outcomes.
With 100% retention of our existing Plan & PBM partnerships,
we invite you to join us in our mission to ensure that your members
are taking the right medication, at the right time. Together we
can help build healthier lives.
PDP
PharmMD appreciates 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.
5 Star > 36.7
4 Star 27.2 to 36.7%
3 Star 16.6 to 27.2%
2 Star 8.5 to 16.6%
1 Star <8.5
MA-PD
•PharmMD completes nearly
180,000 CMRs and increases the
average CMR by 17.1%, 2 star
increase on average
5 Star > 76%
4 Star 48.6 to 76%
3 Star 36.2 to 48.6%
2 Star 13.6 to 36.2%
1 Star <13.6%
About PharmMDDynamic, algorithm-based
RV E N TI
O
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O L U TIO
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I F I C AT
IN
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ON
CMS Medicare 2016 Part C & D Star Rating Technical Notes
Provider targeted and
Proof point =
patient data analysis
patient prioritized
claims based evidence
For Health Plans and
population
risk-bearing
identiļ¬es
deviations
from entities that want to improve member and employee health. PharmMD is the proven choice
for pharmacy qualityclinical
solutions.
Founded
best practices 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.
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