PQA identified six objectives to advance medication therapy management (MTM) quality and measurement, highlighted in the first blog on PQA’s MTM initiative. One ongoing objective is to increase the patient-centeredness of MTM services in the Medicare Part D MTM program. Another is to conceptualize new MTM quality measures.

A key strategy to meet these objectives is the development of an MTM patient-reported outcome measure (PROM) aligned with the Part D MTM program goals for comprehensive medication reviews (CMR). These goals for CMRs are improving patients’ medication knowledge, identifying and addressing medication- and health-related concerns, and empowering self-management.

Stakeholders are calling for new outcome-focused quality measures for the Part D MTM program. However, measure specifications require data sources and methods of data collection that are feasible and preferably digital. Data sources used to calculate quality measures influence the reliability, validity, feasibility, and usability of the measure.

Unfortunately, the current beneficiary-level MTM program reportable data elements required of Part D plan sponsors are not sufficient for clinical and outcome-focused measurement. The use of patient-reported information to assess CMRs would provide meaningful insights for quality improvement, moving beyond the current CMR completion rate process measure.

A CMR-focused PROM would provide MTM providers with actionable information prior to the CMR service and enable patients to influence their overall experience. Years of PQA and partners’ research on this topic include a literature review, CMR transcript analysis, key informant and patient interviews, and the development of a checklist for CMRs to assist with service standardization. The efforts culminated in the creation of a CMR Patient Experience Framework and development of a draft CMR PROM.  

It is important to note that the PROM itself would not serve as a quality measure. Instead, it would equip MTM providers with important personalized patient information necessary to tailor their approach to the provision of CMR services. However, the implementation of a PROM, if used both before and after CMRs to produce change scores, could lead to a potential patient-reported outcome performance measure (PRO-PM) and serve as a patient-centered signal of quality.  The PROM would be the instrument, and the PRO-PM would be the way the instrument is used to evaluate health care quality performance.

The next steps to advance the patient-centeredness of the CMR service and provide the groundwork for a potential PRO-PM for the MTM program include integrating payer and provider feedback into the PROM tool to meet stakeholder needs, collecting patient input on the tool, and piloting the tool in vendor platforms.

Organizations interested in collaborating with PQA to refine and pilot the tool or provide financial support should contact PQA at [email protected].