To Improve CMR Rates, Time Is Everything

Now’s the Time to Test Engagement Strategies To Improve CMR Rates in 2016

The Centers for Medicare and Medicaid Services (CMS) has revealed the highly anticipated Cut Points for the new Medicare Part D CMR Completion Rate Measure that will require many Plans to make a significant shift in strategies to improve CMR rates. Earlier this year, Clinical Support Services (CSS) examined CMS’ most recently reported CMR completion rates by Plan and, if comparing these rates to the new CMS Cut Points, approximately 96% of Part C and D Plans are currently below the 48.6% completion rate required to achieve a Four STAR rating.

CMR Rate and STAR Ratings Chart

Being a Process Measure, CMR rates do not carry the same weight as Improvement Measures; but a Plans’ ability to proactively control and adapt their strategies to improve CMR rates throughout the program year makes this measure a low-lying fruit in the STARs arena.

Achieving a Four or Five STAR rating is not an impossible feat, but it will require changes to the traditional CMR acquisition playbook. Plans will need to extend beyond either telephonic or face-to-face CMRs and deploy non-traditional tactics to engage the member. Plans should be considering how they might deploy the resources of “natural” caregivers, meld plan-based care management and medication therapy management (MTM) and engage the prescriber network. In addition, plans will likely need to consider incorporating marketing and patient engagement strategies into their MTM process (more to come on this in CSS’ next blog).

To have the best chance for success, Plans should be experimenting through this last quarter of 2015 so that they can hit the ground running in 2016.

As the saying goes, “Every system produces exactly what it has been designed to produce”. If this adage has any veracity then plans will need to adopt a Lean strategy to improve CMR rates – designing, evaluating and redesigning the CMR acquisition process in quick, short (less than two month) cycles. CMR improvement of the type CMS is requesting will require “guerilla” experiments to identify and validate unlikely methods of acquiring CMRs. To have the best chance for success, Plans should be experimenting through this last quarter of 2015 so that they can hit the ground running in 2016.

While Medicare Part D Medication Therapy Management Programs (MTMP) should have been submitted to CMS in May for the 2016 program year, Plans still have two months to establish a game plan to improve CMR rates. CSS has long travelled the learning curve that Medicare Plans now face to improve CMR rates and in 2013 began ramping up our focus in this particular area of the MTMP process. If you wish to discuss your MTMP and/or CMR acquisition strategies, contact CSS Founder and President, Jim Notaro at jnotaro@csshealth.com or 716.541.0273 x101.