Advancing The Profession of Pharmacy

New CMR Completion Rate Measure: Is Your Pharmacy Ready?

by | Nov 1, 2015 | MTM Entrepreneurship

If you haven’t heard yet, Centers for Medicare and Medicaid Services (CMS) has been getting  behind Medication Therapy Management (MTM) in a big way.  We learned a few weeks ago about CMS’s plans to unveil the new Enhanced MTM model for plan participation in selected regions.  This is an attempt to allow Medicare Part D plans more flexibility in choosing which members may be deemed eligible for MTM programs.  The goal of the program is to collect data, increase cost savings and get an idea of MTM benchmarks.

In addition to the Enhanced MTM model, CMS will consider Comprehensive Medication Reviews (CMR) completion rate an official “Star Ratings measure” starting in 2016.  This means that pharmacies with lower CMR completion rate may find themselves cut out of contracting with plans with increased reimbursement models.  As plans continue to find ways to increase reimbursements from CMS, Star Ratings will continue to be the benchmark for best performing plans.

If you are in an independent pharmacy and have no idea where to start, this is the guide for you.  

A complete guide to getting your “clinical retail” pharmacists and “MTM lead” pharmacy technicians set up to implement MTM.  Your pharmacy may even want to consider setting up a separate “MTM only” email account and giving everyone access.

In order to contract with OutcomesMTM you will need to go to their website and fill out the required information.

I suggest creating a shareable Google document for your pharmacy so that you can keep everyone’s information organized and up to date.  New employees or independent consultant pharmacists can be added online as well.  Creating a shareable Google calendar for your organization to use for scheduling patients is also a good idea, but that topic can be focused on another day!

To contract with Mirixa, you can call 866.218.6649 or fill out an application online here.

In order to add new user authorization requests, there is a PDF document that must be printed out and FAXED in.  This is the only way Mirixa will allow new users to be added.

Once you have gotten your pharmacy contracted with each of these MTM platforms you will need to set up a plan.  Most pharmacies will have an MTM lead pharmacist and an MTM lead technician.  These will be the people that are responsible for checking the MTM-dedicated email account and the MTM dashboards every day.

Mirixa and OutcomesMTM both announced new plans for adherence checks and patient adherence education that are time-sensitive (7-10 days).  

Checking daily is the only way to identify non-compliance and intervene in a timely fashion. 

If your store needs assistance in setting up a new MTM program, I encourage you to contact me directly here or get into contact with your state chapter of APhA and find out if there are any Independent MTM Consultant Pharmacists in your area.

We also welcome everyone to join our Newsletter and stay up to date on all things MTM!

About the Author

Blair Thielemier, PharmD, is an MTM consultant pharmacist specializing in pharmacy billing models. She consults on and produces e-learning programs for state and national organizations, pharmacy wholesalers, payers, technology start-ups. She has books and online courses available for individuals looking to leverage their pharmacy knowledge into monetized clinical programs at PharmapreneurAcademy.com. She speaks internationally about trends in leveraging pharmacists to improve value-based care.

 

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