Support for Enhanced Medication Therapy Management Implementation

Older man with prescription bottle

Designed to improve medication use and outcomes and reduce the risk of adverse events for Medicare beneficiaries, medication therapy management (MTM) programs were included as a quality improvement requirement under the Medicare Modernization Act of 2003. However, the MTM program at that time did not offer Part D sponsors financial incentives to provide comprehensive MTM programs or encourage beneficiary to participate in MTM service offerings.

Read more about the Part D Enhanced MTM Model in a report published by CMS after the new performance-based payment model was implemented.

From 2017 to 2022, AIR helped the Centers for Medicare & Medicaid Services (CMS) implement a new performance-based payment model, providing technical implementation support services prior to and during the five-year Part D Enhanced MTM Model test. Tasks included data collection, analysis, and performance monitoring of participants (stand-alone Part D plans in five U.S. regions). Specifically, we:

  • Developed performance measures and conducted quantitative and qualitative data analyses to monitor model implementation;
  • Developed technical specifications for a new dataset to be submitted by plan participants—the Enhanced MTM Encounter Data will be used to monitor MTM services provided by the plans;
  • Completed performance payment eligibility calculations;
  • Provided administrative claims data to participants so that they can optimize delivery of enhanced MTM services to Medicare beneficiaries; and
  • Managed a helpdesk to support plans participating in the Model.

The AIR team, made up of managing directors, project managers, senior researchers, analysts, and specialized programmers, included experts in pharmaceutical health services delivery, CMS program implementation, MTM, quality measurement, and Medicare data analysis within CMS data systems.