Q&A with Mel Nelson and DeBran Tarver on Evaluating CMR Services

Mel Nelson (left) DeBran Tarver (right)A comprehensive medication review (CMR) is a medication therapy management (MTM) service designed to systematically collect and assess patient medication information and identify medication therapy problems (MTPs) to develop a care plan for resolution. To ensure Medicare Part D plans are actively engaging in annual CMRs, the Centers for Medicare & Medicaid Services (CMS) added the PQA measure, Completion Rate for CMR, to the Medicare Part D Star Ratings Program. This measure assesses the annual percentage of completed CMRs for eligible beneficiaries.  

Evidence demonstrates that CMRs provide value; however, the extent of uniformity in telephonic service delivery is not well known, making it difficult to assess which CMR components contribute to quality CMR services. Moreover, there is a lack of literature describing which components are most important to MTM stakeholders. 

The first in a series of recently published articles in the Journal of the American Pharmacists Association (JAPhA) highlights findings for the first of three objectives from a PQA collaborative research project to document CMR content coverage and investigate variation CMR services. A follow up article in JAPhA characterizes the current state of comprehensive medication review (CMR) services from diverse stakeholder perspectives 

Mel Nelson, PQA’s Director of Program Management, and DeBran Tarver, PQA's Research Scientist, provide insights in this Q&A blog on the research conducted, the results revealed and PQA’s continued research activities related to CMRs.   

What added information has this project revealed about the state of telephonic CMR services?   

To investigate variation in CMR services, the first objective was to identify and document key CMR components through a scoping literature review and key informant interviews. 

The scoping literature review revealed that there is little accessible information about CMR components. However, six CMR component themes were identified across the small sampling of documents that fit the search criteria. Those included content (topics to be covered by the MTM provider), coverage (availability and suitability of services for various subpopulations), eligibility requirements, recommended encounter frequency to complete CMR services, processes, and patient responsiveness.  

To further understand the state of CMR services, we conducted semi-structured interviews with key informants, including MTM standards and guidelines experts, MTM providers and vendors, and payers. The interviews examined the six themes discovered in the scoping review. They elicited additional perspectives on each organization’s CMR definition and goals as well as informant viewpoints on future expectations for the field. 

There were many agreements with the scoping review and among informants; however, we found interesting points of divergence in perspective. For example, some informants emphasized patient CMR acceptance rates, while others stressed CMR completion rates.  

Variation in the literature and key informant responses validated the need for the remaining project objectives to observe real-world CMRs across settings and delineate variations across all three sources. Additionally, when asked about future predictions, most informants expressed a need for patient-centered methods to evaluate CMR quality, further underscoring the need for continued research 

Will PQA implement any activities or educational opportunities related to this important work? 

Two additional manuscripts are currently in review to build upon the findings in the initial two published articles to share the findings of the second and third objectives. The second objective was to explore components covered in real-world CMRs across settings, while the third objective investigated variation in components covered. Additionally, PQA has collaboratively educated on all findings through podium and poster presentations at several annual national pharmacy and public health conferences.   

An upcoming educational session will be held at the International Society for Quality in Healthcare (ISQua) 38th International Conference in Brisbane, Australia, October 17-20, 2022. The session will be presented by study partners from the University of Arizona. 

More broadly, PQA continues to support the important work of MTM stakeholders across the health care continuum through education and convening opportunities.  

These articles mentioned PQA’s performance measure, Completion Rate for CMR. What other measures does PQA have that could address MTM services, including CMR?  

MTM services can be assessed in multiple ways. The Completion Rate for CMR performance measure and Medication Therapy Problem Resolution (MTPR) monitoring measure are two health plan measures that focus on medication management services and are endorsed by PQA members. 

The MTPR measure is based on the PQA Medication Therapy Problem Categories Framework and evaluates the percentage of interventions that resolve medication therapy problems among individuals participating in an MTM program. 

The framework is intended to standardize how MTPs identified during MTM encounters are categorized within quality measures, which promotes consistent categorization and coding of identified problems and the related actions/recommendations to resolve them. 

PQA also has two quality improvement indicators, which are metrics used by organizations solely for internal quality improvement, that focus on MTM. One is for the Provision of Medication Therapy Management Services Post Hospital Discharge, and the other is for Readmission of Patients Provided Medication Therapy Management Services Post Hospital Discharge. 

What additional research will PQA undertake based on these findings?  

Numerous stakeholders, including MTM vendors, health systems, and independent pharmacies, have expressed an interest in testing and using a patient survey tool to evaluate patient experience during and following a CMR. The current phase of this collaborative project involves interviews with patients who have recently received a CMR. The focus of the interviews is to elicit aspects of the CMR service experience that are most meaningful to patients. We will develop a patient-reported comprehensive medication review experience questionnaire based on the patients’ experiences and a literature review.  

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