In 2021, 48 million Medicare beneficiaries enrolled in Part D plans. Medication therapy management (MTM) for Medicare Part D endeavors to prevent dangerous drug mixes, overmedication, and drug misuse among people with certain qualifying chronic medical conditions.
For years, Medicare’s MTM model incentivized compliance with a minimum set of standards that failed to target at-risk patients. This caused patients to slip through the cracks and reduced efficiency.
The result was a program that modestly reduced expenditures without greatly improving outcomes. The Enhanced Medication Therapy Management model, implemented in 2017, endeavored to fix some of the problems with the original program.
The enhanced MTM program is part of Medicare’s Part D Payment Modernization Model, an experimental program ending in 2022.
Enhanced MTM: A Medicare Success Story
Among people over the age of 65, 44 percent of men and 57 percent of women take five or more medications. This heavily increases the risk of drug-drug interactions, medication misuse, and medication noncompliance.
Medication errors can be lethal, and missed doses can increase preventable patient morbidity, mortality, and healthcare expenditures. From 1999-2019, fatal opioid overdoses claimed nearly 500,000 lives. And 6 percent of Americans, including Medicare beneficiaries, abuse prescription drugs.
The enhanced MTM program is a powerful counter to these alarming data points. Under the enhanced MTM program, health plans can choose which patients to target for interventions, with the ultimate goals of boosting medication compliance, identifying unnecessary medication use, reducing adverse medication effects, and supporting patients at high risk of dangerous drug-drug interactions.
Two years of data show that targeted medication reviews met unmet patient needs. The results are overwhelmingly positive:
- Significant reductions in acute inpatient admissions
- Increases in medication adherence
- Reductions in emergency department visits
Interestingly, the greatest benefits were among patients who had known medication-related issues. This demonstrates that broad targeting of Medicare patients offers fewer benefits than specific targeting of patients who stand to benefit from the program. The latter approach costs less but offers greater benefits, delivering significant value to patients and payers.
Overall, participating plans saved 3.55 percent—or $684 million across 1.7 million beneficiaries—in the first two years. Plans that achieved greater reductions earned performance incentives, pointing to the ongoing value of this program to participants. According to the Centers for Medicare and Medicaid Services (CMS), 14 of the 22 plans achieved greater than 2 percent reductions in spending, six plans saw reductions less than 2 percent, and only two plans saw increases in spending.
Data Tells the Story
Data is critical to track the success of enhanced MTM in your organization. In 2022, at the end of the experimental phase of the Part D Payment Modernization Model, Medicare will determine whether to retain enhanced medication therapy management incentives and whether to offer them more broadly. Payers who hope to capitalize on this opportunity must have quality risk stratification data.
AllazoHealth’s smart data helps pharmaceutical manufacturers, payers, and pharmacies comply with enhanced MTM, measure results, and improve patient outcomes while reducing costs. Companies that implement enhanced MTM with the help of AllazoHealth stand to become more competitive and better serve their patients.
To do this, we gather information about patients, then use artificial intelligence (AI) to identify the highest risk populations and the interventions most likely to improve their outcomes. Then, our AI engine analyzes historic patterns in individuals that share patient characteristics. This identifies the relative risks of plan beneficiaries, then recommends personalized interventions to reduce medication errors and optimize medication compliance. Targeting the right patient populations decreases overall expenditures and improves outcomes.
About the Author
Clifford has been driving the use of AI in patient engagement and outcome optimization for nearly a decade. Upon founding AllazoHealth, Clifford built an industry-leading predictive analytics engine which has won multiple awards and whose impact has been validated through multiple peer reviewed studies. Clifford led AllazoHealth through its formative years and has transitioned to the CTO role as AllazoHealth has grown. Before founding AllazoHealth, Clifford developed CVS Health’s award-winning Pharmacy Advisor medication adherence program in collaboration with AllazoHealth’s current CEO William Grambley, which earned the “2011 Rx Benefit Innovation Award” from the Pharmacy Benefit Management Institute and a “Best Practices in Health Care Consumer Protection and Empowerment Award” from URAC. Earlier in his career, Clifford led the development of analytics software for Boston Consulting Group’s health care practice. Clifford graduated from the University of Pennsylvania’s dual-degree Management & Technology program where he studied management, engineering and mathematics. He entered the Wharton Health Care Management MBA program, but left to start AllazoHealth.