Part D Enhanced Medication Therapy Management Model

The Part D Enhanced Medication Therapy Management (MTM) model tested whether providing Part D sponsors with additional payment incentives and regulatory flexibilities promoted enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures. The model was an opportunity for stand-alone basic Part D plans to right-size their investments in MTM services, identify and implement innovative strategies to optimize medication use, improve care coordination, and strengthen health care system linkages.

There were six Part D sponsors participating in the Part D Enhanced Medication Therapy Management Model.

• Blue Cross and Blue Shield Northern Plains Alliance
• Blue Cross and Blue Shield of Florida
• CVS Health
• Humana
• UnitedHealthcare
• WellCare Prescription Insurance

Background

The Part D Enhanced Medication Therapy Management (Enhanced MTM) model represented an opportunity for stand-alone basic Prescription Drug Plans (PDPs) in selected regions to offer innovative MTM programs, aimed at improving the quality of care while also reducing costs. As part of the “better care, smarter spending, healthier people” approach to improving health delivery, CMS and accepted participants tested changes to the Part D program that might achieve better alignment of PDP sponsor and government financial interests, while also creating incentives for robust investment and developing innovative MTM targeting and interventions. The objectives for this model were for stand-alone basic PDP sponsors to learn how to “right-size” their investment in MTM services and identify and implement innovative strategies to optimize medication use, improve care coordination, and strengthen health care system linkages.

Initiative Details

The Enhanced MTM Model had a five-year performance period that began January 1, 2017. CMS tested the model in 5 Part D regions: Region 7 (Virginia), Region 11 (Florida), Region 21 (Louisiana), Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming), and Region 28 (Arizona). Participating basic stand-alone PDPs in these regions, upon approval from CMS, varied the intensity and types of MTM items and services based on beneficiary risk level and sought a range of strategies to individualize beneficiary and prescriber outreach and engagement. Participants leveraged the core competencies of their own organizations, and of their network pharmacy providers, with those of medical prescribers to accurately identify and effectively intervene with all beneficiaries whose issues with medication management have caused, or were likely to cause, adverse outcomes and/or significant non-drug program utilization and costs. Participants for the model were chosen in August 2016.

Questions regarding the Part D Enhanced MTM model may be directed to EnhancedMTM@cms.hhs.gov.

Evaluations

Latest Evaluation Report

• Two Pager: At-A-Glance Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - Fifth Evaluation Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - Fifth Evaluation Report Appendix A (PDF)
  • Part D Enhanced Medication Therapy Management Model - Fifth Evaluation Report Appendix B (PDF)

Prior Evaluation Reports

• Two Pager: At-A-Glance Report (PDF)
  • White Paper - Synthesis of Evaluation Results Across 21 Medicare Models (PDF)  |  Slides (PDF)  |  Recording (MP4)  |  Transcript (PDF)
• Two Pager: At-A-Glance Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - Fourth Evaluation Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - Fourth Evaluation Report Appendix A (PDF)
  • Part D Enhanced Medication Therapy Management Model - Fourth Evaluation Report Appendix B (PDF)
• Two Pager: At-A-Glance Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - Third Evaluation Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - Third Evaluation Report Appendix A (PDF)
  • Part D Enhanced Medication Therapy Management Model - Third Evaluation Report Appendix B (PDF)
  • Part D Enhanced Medication Therapy Management Model - Third Evaluation Perspective Report (PDF)
• Two Pager: At-A-Glance Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - Second Evaluation Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - Second Evaluation Report Appendix A (PDF)
  • Part D Enhanced Medication Therapy Management Model - Second Evaluation Report Appendix B (PDF)
  • Part D Enhanced Medication Therapy Management Model - Second Evaluation Perspective Report (PDF)
• Two Pager: At-A-Glance Report (PDF)
  • Part D Enhanced Medication Therapy Management Model - First Evaluation Report (PDF)

Additional Information

• Announcement (PDF)
• Fact Sheet
• Fact Sheet - First Year Results (PDF)
• Fact Sheet - Second Year Results (PDF)
• Press Release
• Request for Applications (PDF)
• Enhanced MTM Evidence Base (PDF)
• Prescriber Technical Expertise Panel (PDF)
• Response to Stakeholder Inquiries (PDF)

Model Participant Resources

• Enhanced MTM Encounter Specification Plan (PDF)
• Enhanced MTM Encounter Specification Appendix (XLSX)
• Enhanced MTM Encounter Specification Plan Public Comment Summary (PDF)

Model Learning Events

• Webinar: Introduction (Oct. 21, 2015)
• Webinar: State of the Art for Standards and Interoperable for Data Exchange (Nov. 18, 2015)
• Webinar: Enhanced Medication Therapy Management: Innovations in HIT-enabled MTM-related care (Dec. 15, 2015)