Cardinal Health blog: Only 1% of eligible Medicare Part D beneficiaries get MTM services
DUBLIN, Ohio - Healthcare leaders are being pushed hard across the board to lower costs while raising quality. Medication Therapy Management has been hailed by many, including the federal government, as one way to accomplish this important goal, especially in Medicare Part D. In fact, the Center for Medicare & Medicaid Services states that MTM is a "cornerstone" of Part D's future and a practice that will "serve as a model for achieving quality."
So, then, why do only 1% of eligible Medicare Part D beneficiaries get MTM services today? And what must health insurance plans do to reap the MTM benefits in CMS' Five-Star Quality Ratings System and in what other ways?
In a new blog post on Cardinal Health's online thought leadership website, Essential Insights, Brad Tice shared his perspective on why more patients aren't receiving MTM services, and how health plans can maximize the benefits of MTM services in both the short and long term.
"Today, only a small share of Medicare Part D beneficiaries receive MTM services because health plans identify only 10% of members as eligible and, of these, only 10% get a Comprehensive Medication Review," Tice wrote. "That means only 1% of Part D beneficiaries — 10% of 10% — get this 'cornerstone' benefit of Part D's future. This large disconnect between health plans and CMS cannot last."
According to Tice, the following are four steps health plans can take to ensure more eligible beneficiaries receive this important Medicare Part D benefit:
Improve your reach. Reach members where they receive care. Partnerships with providers who see patients frequently — retail pharmacies and long-term care facilities, for example — are crucial for connecting to the high-risk Part D patients whom CMS wants to receive MTM services;
Find new allies. When incentives are properly aligned, pharmacists have a proven ability to improve patient care in a cost-effective way. Properly structuring payments will dramatically improve outcomes. View the pharmacist as a Star Ratings ally;
Measure and maximize ROI. A lot of focus has been on the question, "What is the ROI on MTM services?" First ask, "What is the cost of inappropriate medication use?" The answer is about $300 billion annually. Then ask, "What is the ROI on a physician visit? On other forms of care?" If a medication is not used correctly, most of these costs will have gone to waste, not to mention the savings that will be missed from the prevention of disease progression; and
Leverage data to find new models of care. While payers need to manage their populations across often broad geographies, individual care for these populations occurs at a local level. Therefore, collaborating with providers, who have the local reach, is key to innovation. These collaborative initiatives — electronic data sharing, business models that incorporate pharmacists, MTM consultations on specialty medications, care across distribution channels and so on —are the waves of the future.