Enhanced Medication Therapy Management Model Shows No Significant Savings for Medicare

The CMS Center for Medicare and Medicaid Innovation's Part D Enhanced Medication Therapy Management (MTM) Model did not show significant savings in its first three years, according to an August 2021 evaluation conducted by Acumen, LLC. In each year, CMS's combined payments to participating plan sponsors were larger than the decreases in Medicare Parts A and B spending, offsetting the cumulative savings of $2.21 per beneficiary per month (PBPM) over the course of the program. While the cost of care delivery in inpatient and institutional post-acute settings decreased, suggesting that the model may help reduce hospital readmissions, an unexpected increase in spending and utilization of emergency room services neutralized the financial impact. And because beneficiaries were encouraged to make follow-up visits to their prescribers, this may explain the increased spending in outpatient and ancillary settings. Overall, while the demonstration did correlate to improvement in some areas, CMS said it likely won't repeat this type of financial model in the future.

 

 

SOURCE: CMS, "Evaluation of the Part D Enhanced Medication Therapy Management (MTM) Model: Third Evaluation Report," submitted by Acumen, LLC to the Center for Medicare and Medicaid Innovation, August 2021. Visit https://bit.ly/3ALOCO5.