The Pharmacy Quality Alliance

In 2011, the Pharmacy Quality Alliance (PQA) endorsed a quality performance measure related to medication therapy management (MTM) services. The comprehensive medication review (CMR) completion rate measure identifies the percentage of MTM-eligible beneficiaries who have received a CMR during the eligibility period. In 2016, completion of a CMR will become a full measure for Medicare plans; it was formerly a Centers for Medicare and Medicaid Services (CMS) Star Ratings display measure. It’s important to note there is a two-year lag between the "action"and "reward" year for the Star Ratings, so 2016 ratings are based on 2014 data. Completion of MTM opportunities is more critical than ever, and what you’ve already done matters!

Medicare payers will be the ones being directly measured by CMS on their CMR completion rate and they complete CMRs in multiple ways, including using community pharmacists to deliver. Many payers use a third-party MTM portal such as Mirixa or Outcomes to provide CMR opportunities to community pharmacies, so they will also be monitoring pharmacies' CMR case completion rates via the MTM portals. In 2016, EQuIPP™ will begin including CMR Completion Rate performance for select plans with pharmacy-facing MTM programs. Payers will be looking even more closely at what partners and methods help to increase quality measures including CMR completion and ultimately patient outcomes.^1,2

MTM 101

Top Health Mart^® MTM performers shared some of their common practices and tips for increasing MTM case completion and improving outcomes, including tips on:

• Integrating MTM Into Your Pharmacy's Daily Workflow
• Completing Targeted Interventions
• Completing Comprehensive Medication Reviews
• Leveraging Technicians Effectively
• Additional Tips from High Performing Pharmacies
• Key Resources

HEALTH MART MEMBER BENEFIT RESOURCES

REFERENCES
1. Centers for Medicare and Medicaid Services. CMS MTM Program Requirements and Information. Accessed March 19, 2015.
2. The Patient-Centered Primary Care Collaborative (PCPCC). The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. 2012. Accessed March 19, 2015.