In an effort to help improve adherence, a Medicare test program aims to get prescribers more involved in enhanced medication therapy management (MTM).
“Existing incentives [under Medicare Part D] may not be well aligned with the Medicare program’s interests in robust quality improvement,” according to an announcement from the Centers for Medicare & Medicaid Services on the Part D Enhanced Medication Therapy Management Model Test.
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The new program – to be tested in 11 states – offers Part D insurance plans more flexibility in how plans spend their resources, allowing them to use different kinds of interventions that are risk stratified, based on likelihood of medication adherence issues a plan member might have, according to the announcement.
CMS is recommending that Part D insurers reach out to prescribers and will help them identify at-risk patients, allowing them to order medication histories in advance of appointments and enable them to write orders for pharmacist consults directly from a standard list of services within an electronic medical record system. Among the quality measures plans will be tracked on are whether the prescriber goals of therapy have been achieved.
CMS said this test “will be complementary to [accountable care organizations] provider-based clinical management, and the combination of the two models will be mutually reinforcing.” Part D insurers and MTM subcontractors “may involve prescribers and treating physicians in the MTM referral and consultation process, and may establish processes for the electronic exchange of interoperable MTM documentation that integrate conveniently into prescriber work flows.”
Prescribers, however, will not receive additional compensation for this interaction.
CMS plans to begin testing the models at the beginning of 2017 for 5 years.