Evaluation of Comprehensive Medication Review Completion Rates Using 3 Patient Outreach Models

Medication therapy management (MTM) programs were first introduced as a result of the 2003 Medicare Prescription Drug Improvement and Modernization Act. Since then, the Centers for Medicare & Medicaid Services (CMS) have established minimum requirements for health plans to follow in establishing patient eligibility for enrollment in these programs. The eligibility criteria are based on projected annual Part D medication costs, number of chronic disease states, and number of chronic Part D covered medications. Patients meeting these criteria are automatically enrolled in an MTM program so must ask to be disenrolled from the program if they wish to not participate (opt-out). CMS rates the quality of health plans using the Five-Star Quality Rating System. Star ratings for various metrics are given to health plans based on a scale of 1 to 5 stars, with 5 stars being the highest quality rating that health plans can achieve. The "Medication Therapy Management Program Completion Rate for Comprehensive Medication Reviews (Part D)" was a display measure and is now a performance measure as of 2016. Consumers can view the star ratings and display measures for their health plans during the enrollment period, so these ratings can affect patient enrollments. Additionally, star ratings may also determine bonus payments awarded to health plans. To address the comprehensive medication review (CMR) measure, different outreach models are used by health plans and vendors to complete CMRs. Comparison of the effectiveness of these outreach models has not been sufficiently studied.