POCP Blog

By Bill Hein, Payer/Provider Executive Lead

As a strong believer in harnessing the power of pharmacists as part of the patient care team, I’m pleased to see some critical national action being taken to further evaluate the impact they can have.  Medicare—the Nation’s biggest payer—is taking steps to close the medication adherence gap among beneficiaries.  The Centers for Medicare and Medicaid Services (CMS), the agency that oversees the program, is launching an experimental five-year pilot program to increase medication adherence for Medicare beneficiaries in Part D plans in five parts of the country.  

The new CMS initiative, known as the Enhanced Medication Therapy Management (MTM) model, will offer incentives to stand-alone Part D plans in five areas, through experimental pilots, to boost adherence. The areas are:  Arizona, Florida, Louisiana and Virginia, and a larger region that includes Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming.  The plans can design their own pilots and tailor them to their unique patient populations and geographic needs.

There are several drivers behind this initiative. Among elderly beneficiaries with four or more chronic conditions, medication non-adherence increased from 14.4% in 2009 to 17% in 2011, according to a 2014 Health Affairs analysis. The prevalence (among the sickest elderly) of forgoing basic needs to purchase medicines went from 6.8% in 2009 to 10.2% in 2011. The cost of nonadherence has been estimated at $100 billion to $300 billion annually, including expenditures for avoidable hospitalizations, nursing home admissions, and premature deaths. Chronic diseases are also on the rise, and older Americans are particularly vulnerable. Today, some 70 million Americans aged 50 and up suffer from 4-5 chronic conditions. Treating the chronically ill accounts for $3 out of every $4 spent on medical care, so reducing outlays for chronic disease management through improving medication adherence can result in significant savings to the U.S. healthcare system and improve quality of care.

CMS will accept applications for the Enhanced MTM model via a Request for Applications (RFA), to be released shortly.  Once released, application materials will be available at: http://innovation.cms.gov/initiatives/enhancedmtm/.  As experts in MTM and pilot management, Point-of-Care Partners offers subject matter expertise and a variety of technical assistance in proposal development and project management.  E-mail or call me if we can help.

More information about the Enhanced MTM model test can be found in the model announcement, available at http://innovation.cms.gov/initiatives/enhancedmtm/.  A webinar on the initiative will be held on October 21, 2015. Registration information will be available on the same site.

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