CMS announces Enhanced MTM model, hopes to bring efficiency to Part D

The CMS Center for Medicare and Medicaid Innovation (CMMI) announced a model designed to test strategies to improve the use of medication among Medicare Part D beneficiaries. The new CMMI program—The Part D Enhanced Medication Therapy Management (Enhanced MTM) model—will attempt to more effectively use MTM, to improve health care outcomes and quality. According to the CMS announcement, enhanced MTM also has the potential to lower overall health care costs.

CMMI

Section 3021 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) established the CMMI to test innovative health care payment and service delivery models. A primary goal of the CMMI was to improve the quality of care and reduce Medicare, Medicaid, and CHIP expenditures. The ACA appropriated $10 billion to support Innovation Center activities initiated from FY 2011 to FY 2019.

Enhanced MTM model

The new model will evaluate whether Medicare Prescription Drug Plans (PDPs) that are given additional incentives and flexibilities to innovate will be better able to meet the goals of the MTM programs. CMS wants to test whether changes to PDPs will help meet the MTM goals of: “(1)improving compliance with medication protocols, including high-cost drugs, ensuring that beneficiaries get the medications they need, and they are used properly; (2) reducing medication-related problems, such as duplicative or harmful prescription drugs, or suboptimal treatments; (3) increasing patients’ knowledge of their medications to better achieve their or their prescribers’ goals of therapy; and (4) improving communication among prescribers, pharmacists, caregivers and patients.”

Implementation

The Enhanced MTM model will consist of a five-year performance period beginning on January 1, 2017. CMS plans to test the model in five regions: Region 7 (Virginia), Region 11 (Florida), Region 21 (Louisiana), Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming), and Region 28 (Arizona). Eligible PDPs in each of those regions can apply to vary the intensity and types of MTM interventions they offer. CMS will waive certain MTM program requirements for participating plans during the model’s performance period. Participating plans will be expected to work closely with their network pharmacy providers and local prescribers to identify enrollees with “medication usage that has caused, or is likely to cause, adverse outcomes and/or significant non-drug program costs.” Plans will be expected to offer targeted assistance to those beneficiaries in order to optimize medication use.