MTM Report Illustrates Challenges of Testing Part D Changes

August 19

As CMS looks to scale back its many models and refocus on health equity, the Center for Medicare and Medicaid Innovation (CMMI) is winding down two Medicare Part D models that were intended to test whether giving plan sponsors certain flexibilities and financial incentives would lead to better outcomes and program savings. One of those models — the Enhanced Medication Therapy Management (MTM) model — did not generate any net savings to the Medicare program and was set to end this year, although one expert suggests the evaluation was flawed. The other model was only in its second year and saw very little interest, and both demonstrate how difficult it is to make significant changes through voluntary Part D models.

Enhanced interventions to improve Part D beneficiaries’ medication use have had a modest impact on beneficiary outcomes but, when taking into account enhanced payments to plans, have not resulted in savings to the Medicare program, according to the third evaluation report on the Enhanced MTM model that began in 2017. Save for two participants’ performance during a single year, “there have been no significant cumulative Modelwide impacts on total gross Medicare Parts A and B expenditures,” observed the report, which was prepared by Acumen, LLC. In fact, in each of the three model years assessed, sponsors’ payments exceeded the non-significant decreases in gross Medicare Parts A and B expenditures (see infographic).

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Radar on Medicare Advantage

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.