Relentless Health Value

Medicare plans in this country need to achieve star ratings. CMS uses these so called Star Ratings to measure how well Medicare Advantage and prescription drug (Part D) plans perform. There’s a few main categories, including quality of care and customer service. Then there’s MTM, Medication Therapy Management, which is part of the comprehensive medication management star rating. This is the idea that a medicare plan gets pharmacists to counsel patients and do other things to help patients get the right drugs or combination of drugs to improve their outcomes. Unsurprisingly for anyone in the healthcare industry, it’s a logistical, economic and clinical hairball. Lisa Erwin explains.

Lisa R. Erwin is President of The E2 Group, LLC a managed markets consulting company that specializes in Medicare Part D clinical program strategic and operational expertise with a strong focus on Quality and Star Ratings.  She also serves as VP of Clinical Strategies for Aventria/Pinnacle Health Communications, a managed market agency. A common theme of Ms. Erwin’s 30-year pharmacy career encompassing long-term care, managed-care and hospital pharmacy has been a focus on improving the quality of medication utilization in the senior population. Most recently, Lisa held the position of Senior Director, Medicare Clinical Quality for Catamaran, a pharmacy benefit manager based in Schaumburg, Illinois. In her role at Catamaran, Lisa directed the company STAR ratings strategy and developed analytic and clinical intervention programs with an emphasis on close health plan client collaboration. She also has served as Pharmacy Director for Medicare Business at Blue Cross Blue Shield of Michigan, a provider of PDP and MAPD offerings. As Vice President, Clinical Operations for Omnicare, Inc., the largest institutional pharmacy provider in the United States, she oversaw the implementation of clinical and health management initiatives which were which were uniquely designed to serve 1.2 million residents of skilled facilities, assisted living and other institutions in 48 states.

 Erwin is a graduate of the University of Michigan College of Pharmacy and has been credentialed as a Certified Geriatric Pharmacist by the Commission for Certification in Geriatric Pharmacy. She has served as a member of the ASCP Task Force on Medication Therapy Management and the Editorial Advisory Board for The Consultant Pharmacist journal.  Lisa held the position of co-chair of Stakeholder Advisory Panel (SAP-B) for the Pharmacy Quality Alliance (PQA) in 2015 and currently is an appointed member of the Measure Update Panel (MUP) for PQA.

00:00 What is MTM and why is Medication Therapy Management making a resurgence?
02:30 MTM as an effort to improve outcomes for patients.
03:25 Engagement side vs. Hospital side.
05:15 Why MTM is such an arduous process.
06:20 “Who gets paid?”
06:50 The blurred lines in the reimbursement discussion.
08:30 “No one has figured out how to measure the outcome.”
10:35 “Why should we do this AND pay for it?”
13:00 The number of Comprehensive Medication Reviews needed for an average Star Rating.
14:00 The two signals coming out of CMS.
19:20 How the pieces of MTM fit together.
22:25 The Pharmacist’s role in MTM.
26:45 The five or six quality measures causing your health plan the most money/pain.