Evaluation of Comprehensive Medication Review Completion Rates Using 3 Patient Outreach Models

BACKGROUND: Medication therapy management (MTM) programs were first introduced as a result of the 2003 Medicare Prescription Drug Improvement and Modernization Act. Since then, the Centers for Medicare & Medicaid Services (CMS) have established minimum requirements for health plans to follow in establishing patient eligibility for enrollment in these programs. The eligibility criteria are based on projected annual Part D medication costs, number of chronic disease states, and number of chronic Part D covered medications. Patients meeting these criteria are automatically enrolled in an MTM program so must ask to be disenrolled from the program if they wish to not participate (opt-out). CMS rates the quality of health plans using the Five-Star Quality Rating System. Star ratings for various metrics are given to health plans based on a scale of 1 to 5 stars, with 5 stars being the highest quality rating that health plans can achieve. The “Medication Therapy Management Program Completion Rate for Comprehensive Medication Reviews (Part D)” was a display measure and is now a performance measure as of 2016. Consumers can view the star ratings and display measures for their health plans during the enrollment period, so these ratings can affect patient enrollments. Additionally, star ratings may also determine bonus payments awarded to health plans. To address the comprehensive medication review (CMR) measure, different outreach models are used by health plans and vendors to complete CMRs. Comparison of the effectiveness of these outreach models has not been sufficiently studied. OBJECTIVE: To compare the completion rate of CMRs by the University of Florida Medication Therapy Management Communication and Care Center (MTMCCC) for 3 models of patient outreach (cold calling, the initial offer and acceptance of a CMR from the health plan before contact by the MTMCCC, and scheduling of a CMR after mailing a welcome letter from the health plan) used for 3 different health plans. METHODS: This study is a retrospective chart analysis using data obtained from completed CMRs at the MTMCCC for health insurance beneficiaries enrolled in 3 different health plans. The CMR completion rate for 3 models of patient outreach used for 3 different health plans over the service period was compared. The CMR completion rate for this study was calculated using the number of completed CMRs and the total number of beneficiaries who were contacted at least once for the provision of a CMR for each respective model by the MTMCCC. The CMR completion rate calculated for this study is modified slightly from the CMS definition because of limitations in patient population assignment to the MTMCCC. RESULTS: The model in which patients were previously offered and subsequently completed a CMR from their health plans before contact by the MTMCCC had the highest CMR completion rate at 49.8%, compared with 40.5% and 23.8% for the other 2 outreach models. CONCLUSIONS: Offering patients a CMR, and subsequent completion, before provision of MTM services may increase CMR completion rate for health plans.