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5 STAR CMR Rates

In March of 2019 Coe, et. al. published – Patterns and predictors of older adult Medicare Part D beneficiaries’ receipt of medication therapy management(https://www.sciencedirect.com/science/article/abs/pii/S1551741119308137). While the data is somewhat lagged (Medicare beneficiaries who were eligible, offered, and received a CMR in 2013 and 2014) it provides useful insights as to what it takes to achieve 5 STAR CMR rates.

The Study

The Coe study pulled from a population of 5,487,343 (2013) and 5,822,188 (2014) continuously enrolled Medicare beneficiaries to exam a subset of 620,164 (2013) and 669,254 (2014) of these beneficiaries enrolled in the MTM program. The primary measures were MTM eligibility, CMR offer, and CMR receipt.

CMRs were offered to 505,658 (82% – 2013) and 649,201 (97% – 2014) MTM eligible beneficiaries. From 2013-2014 CMR acquisition increased from 81,089 (16%) to 119,181 (18%). The study found that the mean age of CMR recipients was 75 years, the majority were women, white, and without low-income status. In 2014, lower odds of CMR receipt were associated with increasing age, male sex, being a non-white race (except black), dual-eligible, having a hospitalization or emergency department visit, and number of comorbidities.

The CSS Health Experience

The results of this study confirm almost exactly CSS Health’s experience in achieving 4 and 5 STAR CMR rates for its clients. The upshot is that a welcome letter and a few outbound calls are necessary, but not sufficient for achieving high CMR rates.

CMR cut points are now sufficiently high that a strategy that respects the population, and as the Coe study points out, more specifically the disparities in a population is required to achieve 4 and 5 STAR CMR rates. In 2020 MA-PD plans will need to achieve a 79% CMR rate to achieve a 4 STAR rate and an 83% CMR rate to achieve 5 STAR CMR rate.

In most Medicare populations these rates cannot be achieved with “vanilla” telephonic outreach strategy. As CMR rate cut points have risen steadily over the past 3 years CSS has been testing and including CMR acquisition strategies that respect the disparities in a population. These strategies evolve around the recognition that there is no “magic bullet” to achieving high CMR rates and a partnership with the plan to engage multiple CMR acquisition strategies that are specifically “tuned” for each subsets of the population. High CMR rates require:

  • Coordination of MTM with other plan programs such as Care management
  • Combination of MTM with other medication related programs such as post discharge services.
  • Confirmation of the benefit of MTM by members’ trusted providers.
  • Resonation with a service that the patient believes will benefit them and is worthy of engaging in.

In 2019, CSS and its clients were rewarded for theses efforts with high CMR rates. Over 98% of CSS Health clients achieved their targeted 4 and 5 STAR CMR rates. A number of our 5 STAR clients took our Coordination, Combination, Confirmation and Resonation strategy so much to heart that they achieved CMR rates in excess of 90%. This year we will continue to evolve our framework for a high value CMR program.

As always I am happy to discuss any aspect of medication management and approaches to better patient engagement and quality measure improvement. 

Best – Jim

James Notaro, RPh, PhD
Founder and Chief Clinical Officer

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