Strategies to Increase CMR Completion Rates in Medicare MTM Programs

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2 Strategies to Increase CMR Completion Rates in Medicare MTM Programs Erwin Jeong, Pharm.D., FCSHP Clinical Operations Manager, Medicare MTM Program Kaiser Permanente, Southern California October 29, 2016

3 Disclosure Statement Erwin Jeong, Pharm.D. declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

4 24.0% 45.6% PDP CMR Completion Rate (CY2015) MAPD CMR Completion Rate (CY2015) 4 KAISER PERMANENTE ALL RIGHTS RESERVED. October 18, 2016

5 Learning Objectives Summarize data requirements For the Medicare Stars Medication Therapy Management (MTM) Comprehensive Medication Review (CMR) Part D Measure Increasing the number of CMRs Describe methods Medicare Part D MTM programs can use to increase the numbers of CMRs 5 KAISER PERMANENTE ALL RIGHTS RESERVED. October 18, 2016

6 Requirements of a Medicare MTM Program 42 CFR (d) A Part D sponsor must have established a MTM program that: Optimizes therapeutic outcomes through improved medication use Reduces the risk of adverse events Developed in cooperation with licensed and practicing pharmacists and physicians May be furnished by pharmacists or other qualified providers May distinguish between ambulatory and institutional settings CMS.gov Medicare-Prescription Drug Coverage Contracting-Medication Therapy Management. Coverage/PrescriptionDrugCovContra/MTM.html (accessed 1/6/16) KAISER FOUNDATION HEALTH PLAN, INC. October 18, 2016

7 What is a CMR? Interactive, person-to-person, or telehealth review Review of all medications (prescription, OTC, herbal, dietary supplements, etc.) CMS standardized written summary provided CMS memo dated 4/7/15. Subject CY2016 Medication Therapy Management Program Guidance and Submission Instructions. Management-MTM-Program-Submission-v pdf (accessed 1/6/16) KAISER FOUNDATION HEALTH PLAN, INC. October 18, 2016

8 MTM Program Completion Rate for CMR (D15) Patients who had a pharmacist (or other health professional) help them understand and manage their medications % CMR completion = Number of beneficiaries who received a CMR during the MTM enrollment period Number of beneficiaries 18yrs or older at the beginning of the reporting period who enrolled in the MTM program for at least 60 days *100 Exclusion: beneficiaries in hospice any time during the reporting period Weighting value: 1 (process measure) CMS Medicare 2016 Part C&D Star Rating Technical Notes (updated 9/02/2015) KAISER FOUNDATION HEALTH PLAN, INC. October 18, 2016

9 MTM Measure Detail CMS Medicare 2017 Part C&D Star Rating Technical Notes. First Plan Preview (updated 8/3/16) 9 KAISER PERMANENTE ALL RIGHTS RESERVED. October 18, 2016

10 CMR Completion Rate Trend Average of all programs (MAPD, PDP, Employer groups) 35% 30% 25% 20% 15% 10% 5% 0% CY2012 CY2013 CY KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

11 CMR Completion Rates CY2012 CY2013* CY2014 CY2015 PDP 6.3% 10.3% 15.4% 24.0% MAPD 16.1% 22.7% 30.9% 45.6% Average 10.5% 15.5% 28.9%^ * Met specified targeting criteria (non-expansion) ^ Calculated based on all plans with reported data CMS Medicare 2016 Part C&D Star Rating Technical Notes (updated 9/02/2015) Analysis of Calendar Year 2013 Medicare Part D Reporting Requirements Data (Nov 2015). Drug-Coverage/PrescriptionDrugCovContra/Downloads/2013-Part-D-Annual-Report_December-2015.pdf (accessed 12/30/15) CMS.gov. Prescription Drug Coverage General Information. Part C and D Performance Data Part C and D Medicare Star Rating Data (v ). (accessed 1/6/16) CMS Medicare 2017 Part C&D Star Rating Technical Notes Draft (updated 09/06/2016) 11 KAISER PERMANENTE ALL RIGHTS RESERVED. October 18, 2016

12 Medicare Star Cut Points MAPD Plans 1 Star 2 Stars 3 Stars 4 Stars 5 Stars CY2014 < 13.6% 13.6 to 36.1% 36.2 to 48.5% 48.6 to 75.9% >= 76.0% CY2015 < 33.2% 33.2 to 47.7% 47.8 to 58% 58.1 to 76.7% >= 76.8% CMS Medicare 2016 Part C&D Star Rating Technical Notes (updated 9/02/2015) CMS Medicare 2017 Part C&D Star Rating Technical Notes Draft (updated 09/06/2016) 12 KAISER PERMANENTE ALL RIGHTS RESERVED. October 18, 2016

13 Medicare Star Cut Points PDP Plans 1 Star 2 Stars 3 Stars 4 Stars 5 Stars CY2014 < 8.5% 8.5 to 16.5% 16.6 to 27.1% 27.2 to 36.6% >= 36.7% CY2015 < 12.6% 12.6 to 20.2% 20.3 to 33.8% 33.9 to 51.5% >= 51.6% CMS Medicare 2016 Part C&D Star Rating Technical Notes (updated 9/02/2015) CMS Medicare 2017 Part C&D Star Rating Technical Notes Draft (updated 09/06/2016) 13 KAISER PERMANENTE ALL RIGHTS RESERVED. October 18, 2016

14 CY2014 MTM CMR Completion Ratings 250 MTM Star distribution CY Number of plans MAPD avg 2.3 MAPD n=397 PDP n=56 50 PDP avg star 2 stars 3 stars 4 stars 5 stars MAPD PDP CMS.gov. Prescription Drug Coverage General Information. Part C and D Performance Data Part C and D Medicare Star Rating Data (v ). (accessed 1/6/16) KAISER FOUNDATION HEALTH PLAN, INC. October 18, 2016

15 Top MAPD plans in CY2014 (plans with data n=392) Contract Name Parent Organization D15: MTM Program Completion Rate for CMR HEALTHSPRING OF FLORIDA CIGNA 90.7% SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. UnitedHealth Group, Inc. 90.0% KAISER FNDN HP OF THE MID-ATLANTIC STS Kaiser Foundation Health Plan, Inc. 88.6% FLORIDA HEALTH CARE PLAN, INC. Guidewell Mutual Holding Corporation 86.8% KAISER FOUNDATION HP OF GA, INC. Kaiser Foundation Health Plan, Inc. 85.1% KAISER FOUNDATION HP, INC. (CA) Kaiser Foundation Health Plan, Inc. 83.6% CONSTELLATION HEALTH, LLC. Constellation Health, LLC. 81.0% ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION Rocky Mountain HMO, Inc. 76.6% ALIGNMENT HEALTH PLAN Alignment Healthcare USA, LLC 76.6% KS PLAN ADMINISTRATORS, LLC Kelsey-Seybold Medical Group, PLLC 76.1% PRESBYTERIAN INSURANCE COMPANY, INC. Presbyterian Healthcare Services 76.0% CMS.gov. Prescription Drug Coverage General Information. Part C and D Performance Data Part C and D Medicare Star Rating Data (v ). (accessed 1/6/16) KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

16 Top PDP plans in CY2014 (plans with data n=56) Contract Name Parent Organization D15: MTM Program Completion Rate for CMR REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH Cambia Health Solutions, Inc. 45.3% QCC INSURANCE COMPANY Independence Health Group, Inc. 43.4% USABLE MUTUAL INSURANCE COMPANY USAble Mutual Insurance Company 40.3% ASURIS NORTHWEST HEALTH Cambia Health Solutions, Inc. 36.7% CMS.gov. Prescription Drug Coverage General Information. Part C and D Performance Data Part C and D Medicare Star Rating Data (v ). (accessed 1/6/16) KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

17 Leadership support Methods to CMRs Goals Labor Outreach Previous patients Coordination KAISER FOUNDATION HEALTH PLAN, INC. October 18, 2016

18 Methods to Increase CMR Rates Leadership support Commitment from upper leadership of the importance of the measure Goals Define attainable CMR completion rate targets based on past performance KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

19 Methods to Increase CMR Rates (cont d) Labor resources Technicians or support staff: outreaching, scheduling, providing reminders Pharmacy students/residents Dedicated time for pharmacists Third party vendors MTM specific Disease state management KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

20 Methods to Increase CMR Rates (cont d) Outreach Welcome packet Contents: letter, phone number to call, response card/questionnaire Educate patients on what a CMR is (website, flyers, etc.) Incentives Phone outreach on patients who would benefit from an intervention Predictive analytics based on prescription and/or medical claims Targeted populations Use of a Medication User Self Evaluation (MUSE) tool was associated with 2x odds of a patient completing a CMR 1 1 Doucette WR et al. Stimulating Comprehensive Medication Reviews Among Medicare Part D Beneficiaries. AJMC 2015; 21:e372-e KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

21 Methods to Increase CMR Rates (cont d) Using patient self-reported information (MUSE tool) 2 Predicators to obtain a CMR: worrying that medications will do more harm than good; number of pharmacies used; number of medications and conditions Patients that perceived their health to be poorer were more likely to have a CMR No significant difference between active (phone, face-to-face) or passive (letter, bag stuffer) outreach for face-to-face appointments in community pharmacies of a grocery chain 3 Automated voice response systems Letters to patients with specific opportunity e.g. drug copay savings (change from brand to generic) 2 Farris KB et al. Effect of Clinical and Attitudinal Characteristics on Obtaining Comprehensive Medication Reviews. JMCP 2016; 22(4): Huet AL et al. Impact of passive and active promotional strategies on patient acceptance of medication therapy management services. JAPhA 2015; 55: KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

22 Methods to Increase CMR Rates (cont d) Previous enrolled patients Patients who had a CMR in prior years are more familiar with the program Factors that positively influenced patients to undergo a CMR in those who had one in the past 4 : Positive experience with a prior CMR and the perception that it was important to their health Physician support Patients who were offered and completed a CMR in the past had a higher CMR completion rate vs other outreach models 5 4 Doucette WR et al. Factors affecting Medicare Part D beneficiaries decision to receive comprehensive medication reviews. JAPhA 2013; 53: Miller DE et al. Evaluation of Comprehensive Medication Review Completion Rates Using 3 Patient Outreach Models. JMCP 2016; 22(7): KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

23 Methods to Increase CMR Rates (cont d) Coordination and collaboration Consider scheduling CMRs prior to annual wellness appointments with physicians KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

24 the Outcomes Ultimate goals o Patient safety and o Optimizing the therapeutic outcomes of the patient s medications Focus on Star-quality measures Adherence: Statin, Diabetes, Hypertension High Risk Medications in the Elderly Others KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

25 Kaiser Permanente California Medicare MTM CMR completion rates by program year 76.5% 77.6% 80.2% 81.4% 60.2% 67.3% KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

26 KP California Medicare MTM Clinical Outcomes High-risk medications in the elderly 25% 20% 15% 10% 5% 0% High-risk medications in the elderly % 14% 9% 11% 9% 8% Adherence PDC >= 80% Statins 85% 87% Oral hypoglycemics 80% 81% RAS antagonists 86% 87% KAISER FOUNDATION HEALTH PLAN, INC.. October 18, 2016

27 Summary CMR Completion Rate CMS identified process measure Measures the Performance/ Quality of Medicare MTM Programs MTM Programs using multiple methods to increase CMR Completion Rates Leadership Support Setting Attainable Goals Dedicated Resources Outreach Targeting Previously Enrolled Patients Coordination & Collaboration with Others 27 KAISER PERMANENTE ALL RIGHTS RESERVED. October 18, 2016

28 Thank You! Contact information: 28 KAISER PERMANENTE ALL RIGHTS RESERVED. October 18, 2016

29 Self Assessment Questions 1. CMS defines a comprehensive medication review (CMR) as: a. Interactive b. Reconciliation of all medications (prescription, OTC, herbal, dietary supplements) c. Standardized written summary is provided d. All of the above 2. True or False. A method of outreach involves sending the patient a letter with a specific opportunity to improve medication therapy

30 Session Code: Write down the session code. Space has been provided in the daily program-at-aglance sections of your program book. 2. To claim credit: Go to before December 1, L01-P/T