Study: Enhanced Health Benefits from a Tailored Medication Management Approach for Medicare Advantage Part D Participants
July 25 2019 - 9:00AM
Business Wire
Key findings from a Humana Inc. (NYSE: HUM) study, published in
the June 2019 issue of Journal of Managed Care & Specialty
Pharmacy (JMCP), highlight the differences in effectiveness between
medication therapy management (MTM) services and the untapped
potential for certain interventions.
MTM refers to a range of services provided by a health care
professional, usually a pharmacist, to help patients get the most
benefit from their medications and to identify and prevent
medication-related problems. An MTM program is required for
Medicare Part D plans; these services are offered through Humana's
RxMentor program for individuals with Humana Part D plans.
Comprehensive medication reviews (CMRs) and targeted medication
reviews (TMRs) are two medication therapy management interventions
defined by the Centers for Medicare and Medicaid Services (CMS).
CMRs, which are required by CMS to be offered annually to every
eligible patient, involve an interactive review of all medications
taken by a patient. Patients then receive a cover letter, a
personal medication list, and a medication action plan specific to
the patient’s drug regimen.
TMRs represent ongoing medication monitoring to assess
medication use and identify specific actual or potential
medication-related problems such as high-risk medications,
drug-drug interactions, or medication nonadherence. Identified
problems are then addressed by the reviewer with the patient or
prescriber.
The two years of MTM data analyzed in this study revealed that
TMR interventions were associated with statistically significant
reductions in acute inpatient admissions and increases in
medication adherence. CMR interventions were only associated with
reductions in acute inpatient admissions when the patient had a
known medication-related problem. In the most recent year of
analysis, there were significant reductions in emergency department
(ED) visits for participants receiving TMR-only interventions or
CMR interventions in conjunction with TMRs. In other words,
receiving medication therapy management services targeted at
resolving medication-related problems indicated an existing unmet
need, and thus these were the patients who were more likely to
benefit from MTM services.
Medicare Part D plans have some discretion in determining
program criteria, such as the number of medications or types of
conditions that will qualify a patient to receive medication
therapy management services. The CMS stars rating system for
recognizing the quality of Part D plans currently includes a metric
for the proportion of eligible members who complete a CMR. This
incentivizes Part D plans to focus on CMR completion and may limit
investments in TMR activities.
Michael Taday, Associate Vice President of Pharmacy Clinical
Strategies and Operations for Humana Pharmacy Solutions, explains,
“This study highlights how critically important it is for Part D
and Medicare Advantage plans to continue to innovate in their
efforts to contribute to better therapeutic outcomes for the
patients they serve.”
Optimal medication utilization is important for good clinical
outcomes and best use of resources. This study’s findings provide
support for optimizing medication therapy by focusing on resolution
of medication-related problems through TMRs or CMRs in conjunction
with TMRs. Humana’s Enhanced MTM (eMTM) strategy, a CMS Innovation
Center Program where customized and targeted interventions will
replace CMRs as a service type for the 2020 plan year, provides
opportunities to continue to advance patient-centric clinical
pharmacy services, as opposed to pursuing a one-size-fits-all CMR
strategy.
Scott Greenwell, President of Humana Pharmacy Solutions,
comments, “We are excited that this study reveals an opportunity
for our pharmacists to educate and empower patients and coordinate
care with clinicians to improve health outcomes.”
The paper was authored by Humana employees Erin Ferries, PhD,
MPH, Benjamin Hall, PhD, FSA, MAAA, Lilian Ndehi, PharmD, MBA, Phil
Schwab, PhD, and Jamieson Vaccaro, MA, and by former Humana
employee Joseph T, Dye, PhD, RPh.
About Humana
Humana Inc. is committed to helping our millions of medical and
specialty members achieve their best health. Our successful history
in care delivery and health plan administration is helping us
create a new kind of integrated care with the power to improve
health and well-being and lower costs. Our efforts are leading to a
better quality of life for people with Medicare, families,
individuals, military service personnel, and communities at
large.
To accomplish that, we support physicians and other health care
professionals as they work to deliver the right care in the right
place for their patients, our members. Our range of clinical
capabilities, resources and tools – such as in-home care,
behavioral health, pharmacy services, data analytics and wellness
solutions – combine to produce a simplified experience that makes
health care easier to navigate and more effective.
More information regarding Humana is available to investors via
the Investor Relations page of the company’s web site at
www.humana.com, including copies of:
- Annual reports to stockholders
- Securities and Exchange Commission filings
- Most recent investor conference presentations
- Quarterly earnings news releases and conference calls
- Calendar of events
- Corporate Governance information
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version on businesswire.com: https://www.businesswire.com/news/home/20190725005418/en/
Alex Kepnes Humana Corporate Communications 502-580-2990
akepnes@humana.com
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