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CHARACTERISTICS OF AN EFFECTIVE PART D MTM PROGRAM

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  1. Establish proactive and persistent recruitment efforts for the CMR. Rely on medical events such as a recent hospital discharge, in addition to scanning for the usual MTM eligibility criteria.1

  2. Target and aggressively recruit patients to complete a CMR based on information on medical events such as a recent hospital discharge, in addition to scanning for the usual MTM eligibility criteria.

  3. Coordinate care by using trusted community relationships: networks of community pharmacists to recruit eligible MTM candidates, other MTM providers (pharmacists) and prescribers, to make recommendations and discuss identified drug problems.

  4. Employ intensive patient education efforts aimed at addressing adherence barriers, including a comprehensive understanding of why each medication is prescribed.

  5. Document the opportunities that were addressed with the patient for switching to generics or other formulary alternatives, especially if cost-related non-adherence is a concern.

  6. Improve drug adherence by providing a complete list of prescribed medicines.

  7. Address financial barriers to adherence such as high drug costs by potentially switching to generics or less expensive formulary alternatives.

  8. Document the quality and safety of prescribing as part of the MTM intervention record (eg, ACEi/ARBs in patients with CHF and diabetes; cardio-selective beta-blockers in patients with CHF; drug-drug interactions, high-risk medications).

  9. Conduct follow-up, document, and resolve any identified drug safety issues.

  10. Use efficient communication methods to convey medication recommendations to prescribers, including e-prescribing and electronic medical records.

  11. Leverage all available data sources (EHR, registries, claims data) to determine whether gaps in medical care are present, including preventive care and maintenance related to the patient's specific medical conditions.

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2011 MEDICARE PART D MEDICATION THERAPY MANAGEMENT (MTM) PROGRAMS JUNE 30, 2011

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Key research questions that may be addressed by CMS or others in the future to evaluate MTM programs, identify best practices, and evaluate the effects of policy changes may include:

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  • What information and data are useful to enhancing beneficiary awareness of MTM programs and services?

  • What is the best method for evaluating the quality of an interactive, person-to-person CMR and other interventions?

  • Which MTM program eligibility criteria are most useful to beneficiaries in selecting a health plan?

  • Which beneficiaries may derive the greatest benefit from a CMR and other MTM services, or interventions?

  • What is the best method of delivering a CMR and other MTM services (eg, face-to-face, telephonic, telehealth)?

  • What is the complexity of beneficiaries receiving a CMR in comparison to the general Medicare beneficiary population in terms of predicted future health expenditures?

  • Which health professional provides the most efficient and effective CMR, and which individuals are best suited to providing other MTM services and interventions?

  • What effect does a CMR and other services have on beneficiary engagement, activation, and satisfaction?

  • Which patient safety reporting measures have the greatest impact on reducing drug-related morbidity and mortality in Medicare beneficiaries?

  • What are the effects of CMRs and other MTM services on achieving the goals of better care for individuals, ...

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