CMS Seeks to Improve Care, Reduce Costs with Enhanced Medication Therapy Management Model

CMS Seeks to Improve Care, Reduce Costs with Enhanced Medication Therapy Management Model

by John Verhovshek, MA, CPC

Beginning Jan. 1, 2017 the Centers for Medicare & Medicaid Services (CMS) will test Enhanced Medication Therapy Management (Enhanced MTM) model in five Medicare Part D regions:

  • Region 7 (Virginia)
  • Region 11 (Florida),
  • Region 21 (Louisiana),
  • Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming)
  • Region 28 (Arizona)

According to CMS:

…the Enhanced MTM model will assess whether providing selected Medicare Prescription Drug Plans (PDPs) with additional incentives and flexibilities to design and implement innovative programs will better achieve the overall goals for MTM programs, including:

  • improving compliance with medication protocols, including high-cost drugs, ensuring that beneficiaries get the medications they need, and they are used properly;
  • reducing medication-related problems, such as duplicative or harmful prescription drugs, or suboptimal treatments;
  • increasing patients’ knowledge of their medications to better achieve their or their prescribers’ goals of therapy; and
  • improving communication among prescribers, pharmacists, caregivers and patients.

The plan seeks to identify Part D enrollees “whose medication usage has caused, or is likely to cause, adverse outcomes and/or significant non-drug program costs.” Identified individuals “will be contacted by their drug plans, pharmacists, or prescribers and offered targeted assistance…to optimize medication use and avoid any medication-related problems,” with an overall goal “to optimize medication use, improve care coordination, and strengthen system linkages.”

To learn more, visit the CMS website.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 404 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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