Medicare Part D ‘Enhanced’ MTM Model: Not Much To Show After Three Years?
Executive Summary
Medication therapy management program has not produced savings in Medicare spending on medical services or a significant, consistent benefit on improving adherence or reducing hospitalizations, report finds.
The Medicare Part D medication therapy management model that offers plans financial incentives to promote adherence and otherwise improve health did not reduce spending in Medicare Parts A (hospital) or B (physician services) as hoped, and in fact operated at a small loss, according to a recently-released report on the project.
“Over the first three years of model implementation [2017-2019] there have been no significant cumulative model-wide impacts on total gross Medicare Parts A and B expenditures,” said the report, which was prepared for the Centers for Medicare and Medicaid Services by Accumen. “There were also no statistically significant impacts in any individual model year.”
Furthermore, “the model generated net losses in each of the first three model years,” although at a cumulative $147m, the loss was not considered statistically significant, the report pointed out.
As part of the project, which is scheduled to run through 2021, Medicare has paid Part D sponsors roughly $3 to $4 per member per month to participate in the model and has offered a retrospective performance payment to incentivize sponsors to improve beneficiary outcomes and reduce downstream spending.
Six Part D sponsors participated in the model during the three years: SilverScript/CVS, Humana, Blue Cross Blue Shield Northern Plains Alliance, United Health, WellCare, and Blue Cross Blue Shield of Florida. About 1.9m beneficiaries were enrolled in plans offered by the sponsors.
The model is being conducted under the auspices of the Center for Medicare and Medicaid Innovation. By law, Part D sponsors are required to include MTM in their offerings. Such programs are supposed to assure careful management of seniors that take multiple medications for chronic conditions.
CMS has highlighted the potential for MTM to provide significant improvements in the quality of care – and, potentially, significant reduction in downstream costs to the program – by focusing on the patients with the highest utilization of services. However, the agency has been disappointed in the uptake of MTM services. That led to the creation of the demonstration. (Also see "A Powerful Demonstration: MTM May Be Counterpoint To Pricing Complaints" - Pink Sheet, 23 Oct, 2015.)
Sponsors participating in the demo have offered a mix of different services for each MTM intervention. Examples include medication reconciliation, comprehensive and targeted medication review, tailored education, and medication adherence counseling. Sponsors (or their vendors) provided services to their beneficiaries via phone, in-person, and automated methods (e.g., interactive voice response).
Limitations On Improving Adherence, Reducing Hospitalizations
In terms of improvements to medication use, “there were small improvements in adherence to oral antidiabetics and statin use in persons with diabetes,” the report observed. However, “measures of potentially unsafe medication use did not improve for enrollees in model-participating plans as much as for the comparison group,” it added.
Specifically, “the rates of both drug-drug interactions and concurrent use of opioids and benzodiazepines … did not decrease as much as among enrollees in model-participating plans as they did among the comparison group.” These findings “were contrary to expectations.”
The model’s impact on reducing hospital services was also mixed. There were “moderate” decreases in expenditures and some utilization measures in the inpatient and institutional post-acute care settings. But those decreases were “partially offset” by increases in utilization and related spending in the outpatient (emergency and non-emergency) and ancillary settings, the report pointed out.
However, “estimated impacts for measures of medication use and specific settings suggest that the model is improving some beneficiary outcomes and may have reduced certain types of costly utilization (e.g., readmissions), the report noted.