Sound Medication Therapy Management Programs, Version 2.0

BACKGROUND: The Academy of Managed Care Pharmacy (AMCP, theAcademy) contracted with the National Committee for Quality Assurance(NCQA) to conduct a field study to validate and assess the 2006 Sound Medication Therapy Management Programs, Version 1.0 document. Version1.0 posits several principles of sound medication therapy management(MTM) programs: they (1) recruit patients whose data show they may need assistance with managing medications; (2) have health professionals who intervene with patients and their physicians to improve medication regimens;and (3) measure their results. The validation study determined the extent to which the principles identified in version 1.0 are incorporated in MTM programs. OBJECTIVES: The method was designed to determine to what extent theimportant features and operational elements of sound MTM programs asdescribed in version 1.0 are (1) acceptable and seen as comprehensive tousers, (2) incorporated into MTM programs in the field, (3) reflective of the consensus group’s intentions, and (4) in need of modification or updating. SUMMARY: NCQA first conducted Phase One, in which NCQA gathered perspectives on the principles in the consensus document from a mixedgroup of stakeholders representing both providers and users of MTM programs. Phase Two involved a deeper analysis of existing programs relatedto the consensus document, in which NCQA conducted a Web-based survey of 20 varied MTM programs and conducted in-depth site visits with 5 programs. NCQA selected programs offered by a range of MTM-providing organizations—health plans, pharmacy benefit management companies, disease management organizations, and stand-alone MTM providers. NCQA analyzed the results of both phases. The Phase Two survey asked specific questions of the programs and found that some programs perform beyond the principles listed in version 1.0. NCQA found that none of the elements of the consensus document should be eliminated because programs cannot perform them, although NCQA suggested some areas where the document could be more expansive or more specific, given the state of MTM operations in the field. The important features and operational elements in the document were categorized into the following 3 overall categories, which NCQA used to structure the survey and conduct the site visits in PhaseTwo: (1) eligibility and enrollment, (2) operations, and (3) quality management. CONCLUSIONS/RECOMMENDATIONS: NCQA found that the original consensus document was realistic in identifying the elements of sound MTM. In the current project, NCQA’s purpose was not to make judgments about the effectiveness of MTM programs in general or any individual program in particular. NCQA recommended that the consensus document could be made stronger and more specific in 3 areas: (1) specifically state that the Patient Identification and Recruitment section advocates use of various eligibility criteria that may include, but are not limited to, Medicare-defined MTM eligibility criteria; (2) reframe or remove the statement in Appendix A of the consensus document that the preferred modality for MTM is face-to-face interaction between patient and pharmacist, unless there are comparative data to support it as currently written; and (3) specifically recommend that programs measure performance across the entire populations in their plans in addition to measuring results for those patients selected into MTM. This will make benchmarking among programs possible and will lead to substantiated best practices in this growing field.