CMR Best Practices

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For all types of health plans, a Comprehensive Medication Review (CMR), a yearly review of a patient’s medications by a pharmacist, is often viewed as a “check the box” activity as part of a Medication Therapy Management (MTM) program. But if a CMR is viewed as a strategic initiative in a broader medication adherence strategy, it can be a key engagement strategy in pursuit of medication adherence. A CMR gives health plans a holistic view of their member’s medication regimens beyond just a review of prescription medications, identifying any potential gaps in therapy or drug interactions and addressing specific member concerns.

A CMR initiative that is strategically aligned with a medication adherence program can help health plans lower premiums, enhance their member experience and ultimately achieve better outcomes.

Below are some keys to success when building your CMR strategy for 2020:

Don’t Just Plan for the Year, Plan for Years Ahead 
When selecting who to target for the year, it is important to consider CMRs as a part of a broader medication adherence program. CMRs should be focused toward high risk members with conditions that are managed through complex medication regimens. The ultimate goal should be to make an impact by addressing the needs of the most at-need populations, tracking success and moving on to a different population the following year. If a plan continues to reach out to the same population year over year, it runs the risk of member abrasion and low member satisfaction.

Target Smart
When determining what populations to target and which members to reach, it is best to utilize both pharmacy and medical claim data inputs. Often times, a plan can miss a key indicator of non-adherence by not looking at medical claims data in conjunction with pharmacy data. Predictive analytics solutions designed for adherence can be utilized to assist with prioritization of member outreach. Using the combined data sets and a comprehensive rules engine to evaluate your criteria will guarantee more accurate outputs for your member engagement strategy.

Engage with Purpose
Members are contacted by their health plan throughout the year for multiple reasons and by multiple representatives, which means that each interaction has an impact on overall member satisfaction. As plans strive to achieve high member satisfaction scores, the experience a member has during a CMR is crucial to achieving a positive member experience. The best way to ensure that members find a CMR valuable is to go above and beyond reviewing their medications. Pharmacist representatives from health plans should be trained in motivational interviewing techniques to accomplish the goal of influencing members to maintain adherence throughout the year. They should also be prepared to address potential barriers of care. By solving for any adherence issues uncovered in a CMR, health plans increase the likelihood of high member satisfaction and positive outcomes.

Ultimately, the goal of a CMR should be to empower people to self-manage their medications, and ultimately, improve their overall health. To learn more about CMRs and Medication Adherence best practices, subscribe to our blog.