Latest / Pharmacy Podcast Network / CMS’s Intent to Return the CMR Completion Rate to the Star Ratings Program | Outcomes: Insights Beyond the Counter

Transcript

CMS’s Intent to Return the CMR Completion Rate to the Star Ratings Program | Outcomes: Insights Beyond the Counter · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession.
• 0:10
  Speaker 2: Welcome to the Pharmacy podcast Network.
• 0:32
  Speaker 1: My name is Ross Brye, Senior product manager and a
• 0:35
  Speaker 1: residence CMR guy, focusing on medication, therapy management and payer
• 0:39
  Speaker 1: strategies and healthcare. I'll be your guide today as we
• 0:42
  Speaker 1: dive into industry trends and company initiatives shaping the MTM
• 0:46
  Speaker 1: and payer space. With me for the conversation today is
• 0:50
  Speaker 1: Outcomes Director of Payer Products, Cindy Henry. Cindy, if you
• 0:53
  Speaker 1: want to give yourself a brief introduction, sure.
• 0:56
  Speaker 3: Thanks for us, Cindy Henry here. As you heard, I'm
• 1:00
  Speaker 3: director of Payer Product. My background is varied, but if
• 1:05
  Speaker 3: centered in government sponsored healthcare. I have background in working
• 1:12
  Speaker 3: for a health plan as well as working on the
• 1:14
  Speaker 3: vendor side and also pharmacy as well, So I had
• 1:18
  Speaker 3: a little bit of everything and looking forward to bringing
• 1:21
  Speaker 3: that perspective into conversations.
• 1:23
  Speaker 2: The different lenses to look through for sure. Cindy.
• 1:26
  Speaker 1: Yeah, that's really great. Yeah, well, it's awesome to have
• 1:28
  Speaker 1: you here for today's podcast. You know, we're just a
• 1:32
  Speaker 1: couple of short weeks out from CMS and the release
• 1:36
  Speaker 1: of the twenty twenty seven Advanced Notice. Lots of areas
• 1:40
  Speaker 1: in that content to cover a lot of areas getting
• 1:44
  Speaker 1: airtime across social media and otherwise, of course for outcomes.
• 1:50
  Speaker 1: A key area of focus within that advanced Notice is
• 1:53
  Speaker 1: around the MTM Medication Therapy Management Program and seeing CMS
• 1:58
  Speaker 1: again formalized there tent to bring back the CMR completion
• 2:02
  Speaker 1: rate for measure year twenty twenty seven. Cindy, what were
• 2:06
  Speaker 1: your initial reactions as you saw that content and kind
• 2:09
  Speaker 1: of saw reactions elsewhere.
• 2:13
  Speaker 3: I would say there was a obviously brief moment of
• 2:18
  Speaker 3: a sigh of relief or a celebration, quickly punctuated by
• 2:22
  Speaker 3: sort of the reality of all of the different things
• 2:26
  Speaker 3: happening in the landscape where this sits in that landscape.
• 2:30
  Speaker 3: And then as excited as I am to see this
• 2:33
  Speaker 3: come back, I'm also feeling for our health plans and
• 2:38
  Speaker 3: you know, excited for how our network's going to respond
• 2:42
  Speaker 3: to the need.
• 2:44
  Speaker 2: Yeah, I know for me personally.
• 2:47
  Speaker 1: Over the last year or so, as the CMR has
• 2:52
  Speaker 1: been in the display page, now we've seen the industry,
• 2:56
  Speaker 1: you know, reevaluate their strategies for stars. And that's not
• 3:00
  Speaker 1: just because of CMR. That's just one little microcosm in
• 3:03
  Speaker 1: the larger environment of the STAR ratings program and even
• 3:06
  Speaker 1: the larger beyond that the full Medicare program and its entirety.
• 3:10
  Speaker 1: So a lot of changes that are being navigated by plans.
• 3:13
  Speaker 1: I know we've talked about this Cindia. Is it's it's
• 3:16
  Speaker 1: an area that is you know, maybe the term is
• 3:20
  Speaker 1: precarious right now in terms of just how to step
• 3:24
  Speaker 1: forward down that path. I think the biggest thing that
• 3:27
  Speaker 1: you know, I've heard as we've been in conversation with
• 3:29
  Speaker 1: plans is just the strategic planning and thinking that is
• 3:35
  Speaker 1: going into a lot of these moments right now. You
• 3:37
  Speaker 1: know how to take that next step forward, whether it
• 3:40
  Speaker 1: is in your STAR strategy or in your larger strategy
• 3:43
  Speaker 1: as a you know, plan holding a Medicare contract or contracts,
• 3:47
  Speaker 1: how do you make those next moves right in the
• 3:50
  Speaker 1: right way to continue to drive on the themes that
• 3:54
  Speaker 1: CMS you know, cares about today but also what we're
• 3:58
  Speaker 1: seeing CMS intends to care about in the future.
• 4:01
  Speaker 3: So maybe ross what we should do before we dive
• 4:05
  Speaker 3: into strategies and things like that, is maybe to a
• 4:09
  Speaker 3: step back and explain what the CMR measure is and
• 4:13
  Speaker 3: what we do here at Outcomes to help you know,
• 4:16
  Speaker 3: with performance and success in that area. And then maybe
• 4:20
  Speaker 3: just just a quick little bit about how that kind
• 4:24
  Speaker 3: of fits into the overall sort of plan and playbook
• 4:28
  Speaker 3: for Stars and heat of success.
• 4:31
  Speaker 2: Yeah, great, great call out, Cindy. Let's step back for.
• 4:34
  Speaker 1: A moment just to remind our listeners of who we
• 4:37
  Speaker 1: are as outcomes and as as you mentioned, you know,
• 4:40
  Speaker 1: what we bring to the table when it comes to
• 4:42
  Speaker 1: MTM programs and the larger star strategy, so outcomes that
• 4:45
  Speaker 1: we have many decades of experience operating and managing not
• 4:50
  Speaker 1: only MTM programs, but many different aspects of star ratings
• 4:54
  Speaker 1: programs to help with quality measure improvement. Really are you know,
• 4:58
  Speaker 1: value war bringing to the for front is bringing local
• 5:01
  Speaker 1: pharmacy into that entire mix, so bringing local relationships.
• 5:05
  Speaker 3: Yeah, it's kind of having a moment right a community exactly,
• 5:09
  Speaker 3: bridging community resources. I think we've seen this a little
• 5:12
  Speaker 3: bit happening around the SDH space, but now we're seeing
• 5:15
  Speaker 3: even more concentrated effort in this area. So piling you know,
• 5:19
  Speaker 3: layering that on with you know, Mark, I think is
• 5:22
  Speaker 3: important just to call out, But yeah.
• 5:25
  Speaker 2: Sorry, to keep going. No, No, you're exactly right, Cindy.
• 5:28
  Speaker 1: Yeah, the you know, the theme of your local pharmacist.
• 5:33
  Speaker 1: I know when I started that Outcomes in twenty twelve,
• 5:36
  Speaker 1: almost fourteen years ago. Now, you know, our tagline at
• 5:40
  Speaker 1: that point in time was the face to face difference,
• 5:42
  Speaker 1: and you know, I think that resounded in the industry
• 5:46
  Speaker 1: at that point for reasons, and today it resounds for
• 5:49
  Speaker 1: other reasons, like you're alluding to, Cindy, of kind of
• 5:52
  Speaker 1: this hearkening back to local relationships and the ability to
• 5:56
  Speaker 1: support patients where they are, you know, amongst the you know,
• 6:01
  Speaker 1: landscape of healthcare that has continued to expand over that
• 6:05
  Speaker 1: period of time, continue to become more cost burdened over time,
• 6:10
  Speaker 1: how do you really kind of shrink that down, not
• 6:14
  Speaker 1: only from a cost perspective, but just literally from the
• 6:17
  Speaker 1: members experience.
• 6:18
  Speaker 2: Bring that back to home.
• 6:20
  Speaker 1: So that local relationship component is really something that we
• 6:24
  Speaker 1: ad Outcomes see as just a huge opportunity to help
• 6:28
  Speaker 1: healthcare to continue to you know, to lean on those
• 6:33
  Speaker 1: relationships that I know myself as a personal consumer of
• 6:36
  Speaker 1: healthcare for myself and my family becomes so critical and
• 6:41
  Speaker 1: valuable when I can engage in conversation about healthcare with
• 6:47
  Speaker 1: with a local resource that you know can understand our circumstance,
• 6:52
  Speaker 1: can help us to participate in the resources in our
• 6:55
  Speaker 1: in our community that can really allow us to improve
• 6:59
  Speaker 1: our improve our all care, improve our quality of life,
• 7:01
  Speaker 1: all the things that I think each one of us
• 7:04
  Speaker 1: strives for and really helps to accomplish.
• 7:07
  Speaker 2: So I think that's a great point, Cindy from your
• 7:10
  Speaker 2: standpoint too.
• 7:10
  Speaker 1: And that's really what we see come out when you
• 7:13
  Speaker 1: see the patient stories of patients that are receiving services
• 7:17
  Speaker 1: across any of our programs, whether it's helping to improve
• 7:20
  Speaker 1: a patient's adherence, close a gap and care, receive a
• 7:23
  Speaker 1: comprehensive medication review, all those services benefit from a local
• 7:28
  Speaker 1: pharmacist being being able to engage into that conversation. So yeah,
• 7:31
  Speaker 1: that's to your point, Cindy. That is the table we
• 7:34
  Speaker 1: see set in front of us is a nationwide network
• 7:38
  Speaker 1: of pharmacists eager to participate in these quality management programs
• 7:43
  Speaker 1: for health plans and help health plans achieve the quality
• 7:46
  Speaker 1: strategies that they're looking to, you know, accomplish. And now
• 7:50
  Speaker 1: with CMS in the advanced notice reiterating their intent to
• 7:54
  Speaker 1: bring that CMR completion right back.
• 7:56
  Speaker 2: You know, I think it really adds another layer of
• 7:59
  Speaker 2: reality to you know, maybe over the last year a
• 8:03
  Speaker 2: little bit of is it coming back? Is it not
• 8:05
  Speaker 2: coming back?
• 8:06
  Speaker 1: Questioning that we've heard as we've been in conversation with
• 8:09
  Speaker 1: health plans, But ultimately, I don't know that we've ever
• 8:12
  Speaker 1: seen that questioning from CMS.
• 8:13
  Speaker 2: If you look back at any of.
• 8:14
  Speaker 1: The regulatory notices or rule making from CMS, there's really
• 8:20
  Speaker 1: never been a question of the measure coming back. It's
• 8:22
  Speaker 1: always been an intentionality of CMR completion rate is going
• 8:26
  Speaker 1: to be on display.
• 8:27
  Speaker 2: Page for two years.
• 8:28
  Speaker 1: It's a two year period, very hard and set when
• 8:31
  Speaker 1: CMS made that statement, and now we're seeing them say
• 8:35
  Speaker 1: that two year period is up at the end of
• 8:37
  Speaker 1: twenty twenty six and twenty seven measure year.
• 8:39
  Speaker 2: Here we go, CMR completion rate is back.
• 8:43
  Speaker 3: Do you say, would it be safe to say rather
• 8:47
  Speaker 3: that we kind of been have been hedging our bits
• 8:51
  Speaker 3: that it was going to follow sort of the display
• 8:54
  Speaker 3: page cycle that we have seen, the precedent that we've
• 8:56
  Speaker 3: seen with other STAR measures, Even though the communications around
• 9:02
  Speaker 3: you know, policy and these changes has maybe been a
• 9:06
  Speaker 3: little bit outside of the norm from what we can
• 9:09
  Speaker 3: normally expect, which causes a little bit of speculation and
• 9:12
  Speaker 3: a little bit of an sureness for our health plans
• 9:15
  Speaker 3: as they plan ahead. Can you kind of just talk
• 9:18
  Speaker 3: a little bit about sort of what we were planning
• 9:21
  Speaker 3: on and what we saw during the period of before
• 9:24
  Speaker 3: it went to display page and during when it went
• 9:27
  Speaker 3: to display page.
• 9:29
  Speaker 2: Yeah.
• 9:29
  Speaker 1: I love that question because I think it you know,
• 9:33
  Speaker 1: it obviously alludes to the times we find ourselves in.
• 9:37
  Speaker 2: Today of we know where we are as.
• 9:41
  Speaker 1: Of this minute, of this hour of this day, but
• 9:43
  Speaker 1: we might not really know what tomorrow might bring from
• 9:47
  Speaker 1: every aspect of rulemaking and regulatory changes. You know, each
• 9:53
  Speaker 1: day seems to bring a new twist that maybe we
• 9:56
  Speaker 1: weren't anticipating or we felt have followed a different path.
• 10:02
  Speaker 1: So yeah, I think recognizing the space that we're in,
• 10:07
  Speaker 1: I am sure had an impact on plans as they
• 10:12
  Speaker 1: were looking at and evaluating the intentionality of CMS to
• 10:16
  Speaker 1: bring back the CMR completion rate measure as outcomes. You know,
• 10:21
  Speaker 1: we have been really heads down in We've got a
• 10:25
  Speaker 1: two year period of time where this measure is on
• 10:29
  Speaker 1: the display page, a two year period of time to
• 10:31
  Speaker 1: really reinvent what an MTM program looks like of high
• 10:35
  Speaker 1: quality and what the components of that MTM program bring
• 10:38
  Speaker 1: to the table. So not just focused on the outcomes
• 10:43
  Speaker 1: of the CMR itself, but the broader MTM program.
• 10:46
  Speaker 2: And how that can continue to evolve.
• 10:48
  Speaker 1: But within the CMR, really identifying those areas of opportunity
• 10:53
  Speaker 1: for efficiency while balancing high clinical quality just being super
• 10:58
  Speaker 1: super important. So yeah, it's it's it's definitely multifaceted in
• 11:03
  Speaker 1: a lot of different ways. But I don't think it'd
• 11:05
  Speaker 1: be fun any other way.
• 11:08
  Speaker 3: So true, so true.
• 11:11
  Speaker 1: So you.
• 11:13
  Speaker 3: Are often at the forefront of a lot of these
• 11:15
  Speaker 3: conversations as we're meeting with our payer customers. How did
• 11:21
  Speaker 3: the conversations change as you know, the measure has moved
• 11:27
  Speaker 3: into display What shifted in payer strategy during this time?
• 11:33
  Speaker 3: That maybe a little bit risky now that this is
• 11:37
  Speaker 3: becoming more important again.
• 11:39
  Speaker 1: Yeah, so you know, I think the key family saw
• 11:44
  Speaker 1: and this is I think not to be unexpected. Was
• 11:49
  Speaker 1: a move to display page really resulted in MTM programs
• 11:53
  Speaker 1: being viewed as a compliance measure for health plans, you know,
• 11:58
  Speaker 1: maintain compliance of your Medicare contract by uh, you know,
• 12:04
  Speaker 1: continuing forward the activity of your MTM program having that
• 12:11
  Speaker 1: continue to be a component of your Medicare contract. But
• 12:15
  Speaker 1: the actual performance focus of course taking a vac seat,
• 12:20
  Speaker 1: you know, not at all surprising. As we alluded to,
• 12:24
  Speaker 1: the strategies around stars have needed to shift based on
• 12:28
  Speaker 1: the shifting landscape of stars measures over the last you know,
• 12:32
  Speaker 1: a handful of years, and so with the CMR measure
• 12:36
  Speaker 1: moving to display, it allowed for health lends to get
• 12:39
  Speaker 1: that breathing room that CMS really intended by moving the
• 12:43
  Speaker 1: measure onto display because of the substantive changes. So, you know,
• 12:47
  Speaker 1: I think we saw what we anticipated and expected from
• 12:51
  Speaker 1: plans of you know, kind of pulling back the driving
• 12:55
  Speaker 1: force that they had behind CMR completion. Uh, you know
• 12:59
  Speaker 1: previously in measure year twenty four in earlier and now
• 13:04
  Speaker 1: as we see you know, a further emphasis from CMS
• 13:08
  Speaker 1: on the measure returning, we're really seeing that kind of
• 13:12
  Speaker 1: temporary pullback with kind of getting relieved, you know, right,
• 13:19
  Speaker 1: We're seeing the plans re ramping up their interest in
• 13:24
  Speaker 1: how do they scale up into twenty twenty seven in
• 13:28
  Speaker 1: the right way, in a meaningful way.
• 13:31
  Speaker 3: It kind of you know, I think about it if
• 13:34
  Speaker 3: I'm looking from the thousand foot view down on all
• 13:40
  Speaker 3: of the pressures that I see payers facing. You know,
• 13:45
  Speaker 3: margins are reducing, so we're looking at, you know, our
• 13:50
  Speaker 3: sources of revenue which used to have some room or flexibility,
• 13:53
  Speaker 3: they're starting to flatten. At the same time though, and
• 13:56
  Speaker 3: we see this strong messaging from MS around you know,
• 14:01
  Speaker 3: this is about clinical outcomes, which is what stars was
• 14:06
  Speaker 3: supposed to always be about, what pot health has always
• 14:09
  Speaker 3: been about. But I think you know, through the evolution
• 14:12
  Speaker 3: of that, we've seen ways that you know, star ratings
• 14:15
  Speaker 3: are gamified. Star ratings you know, are used as kind
• 14:19
  Speaker 3: of like a give me as far as revenue is
• 14:22
  Speaker 3: concerned for our for our payers. And that's not to
• 14:25
  Speaker 3: say that they aren't putting in the hard work to
• 14:27
  Speaker 3: make sure that you know, care quality as standards are
• 14:31
  Speaker 3: being met and that their patients are seeing improved outcomes.
• 14:34
  Speaker 3: But at the end of the day, right when we
• 14:36
  Speaker 3: talk about bottom dollar and bottom line and what our
• 14:40
  Speaker 3: investments are getting, you know, for us, I think, you know,
• 14:44
  Speaker 3: looking at flattening of some of these you know, revenue
• 14:48
  Speaker 3: sources is got to be concerning and then at the
• 14:52
  Speaker 3: same time being asked to do more right because as
• 14:55
  Speaker 3: we know, and something we can kind of dive into
• 14:59
  Speaker 3: is the denial dominator for the CMR measure is going
• 15:02
  Speaker 3: to be increasing. So now you're doing more, you're deploying
• 15:06
  Speaker 3: a higher cost program. How do you guarantee that you
• 15:09
  Speaker 3: get the outcomes that you need so that you can
• 15:11
  Speaker 3: be successful? So I think that becomes even more critical.
• 15:15
  Speaker 3: And where I would be looking, you know, and there's
• 15:18
  Speaker 3: lots to look at right now. So I think where
• 15:20
  Speaker 3: it makes sense to me for CMR if I'm looking
• 15:23
  Speaker 3: at all of that, is really making sure that there's
• 15:26
  Speaker 3: good proof behind the ROI and that a program can scale.
• 15:30
  Speaker 3: And so I think Ross, maybe you can kind of
• 15:33
  Speaker 3: give us a little bit of background into the growing denominator,
• 15:37
  Speaker 3: what the drivers are for that and sort of what
• 15:39
  Speaker 3: maybe to expect, you know, and that, and then maybe
• 15:43
  Speaker 3: you know, we can talk a little bit about how
• 15:46
  Speaker 3: to strategize for that.
• 15:47
  Speaker 1: Yeah, that's a really you know, useful dynamic. Is you know,
• 15:53
  Speaker 1: the changing strategies as we've talked about already in the
• 15:57
  Speaker 1: MTM landscape over the last year and a half.
• 16:00
  Speaker 2: And then along.
• 16:02
  Speaker 1: With that, though the increasing denominator that we saw at
• 16:06
  Speaker 1: the beginning of twenty twenty five because of standardized MPTM
• 16:09
  Speaker 1: program identification criteria. Now, maybe the saving grace that plans
• 16:16
  Speaker 1: have been hoping for or counting on is the measure
• 16:22
  Speaker 1: coming back as an active measure, has the result of
• 16:28
  Speaker 1: the cut points kind of resetting and recalculating anew in
• 16:32
  Speaker 1: twenty twenty nine based on twenty twenty seven performance. And so,
• 16:39
  Speaker 1: you know, I think as we've been in conversation with plans,
• 16:43
  Speaker 1: a lot of our emphasis and thought leadership has been
• 16:45
  Speaker 1: around providing our predictions of where those cut points will
• 16:51
  Speaker 1: land based on the activity we've seen in these display
• 16:56
  Speaker 1: measure years. You know, So I think to your point,
• 17:01
  Speaker 1: there's of course this component of growing denominator, a potential
• 17:06
  Speaker 1: for growing budget, and how do you manage that budget
• 17:09
  Speaker 1: accordingly based on the value you see as a plan
• 17:14
  Speaker 1: from the services within the MPTM program, but then also
• 17:17
  Speaker 1: alongside of that the value of the Equality Measure performance,
• 17:21
  Speaker 1: and then stack that up against your peers and how
• 17:25
  Speaker 1: they value the MPTM program they're putting their emphasis, And
• 17:29
  Speaker 1: you know, ultimately, I think as we've run our predictions,
• 17:31
  Speaker 1: we've seen that although the re entry of the CMR
• 17:36
  Speaker 1: measure brings the cut points down, right, it's kind of
• 17:40
  Speaker 1: this release of the pressure valve that we saw building
• 17:43
  Speaker 1: over the last decade on this measure. Although it does
• 17:46
  Speaker 1: release that pressure, it is I think very eye opening
• 17:49
  Speaker 1: to see there are a plan still continuing to make
• 17:52
  Speaker 1: strong investments into the EMPTM program because of the value
• 17:55
  Speaker 1: that they are getting out of a robust program that
• 18:00
  Speaker 1: allows for their patients to better manage their medications and
• 18:03
  Speaker 1: health conditions through medication therapy management. And so by nature
• 18:08
  Speaker 1: of the Star ratings program and the CMR Completion rate measure,
• 18:13
  Speaker 1: you see those plans pulling the star rating cut points,
• 18:18
  Speaker 1: and that upward pull results in a lot of shifts
• 18:23
  Speaker 1: in how health plans have traditionally performed in the measure
• 18:26
  Speaker 1: to where they would likely perform in the measure if
• 18:29
  Speaker 1: they're kind of display year performance remained steady into twenty
• 18:35
  Speaker 1: twenty seven, right, So if you, as a health plan
• 18:38
  Speaker 1: said well, I don't see the value at CMR and
• 18:42
  Speaker 1: I'm not going to make the investments, it's a bigger
• 18:43
  Speaker 1: investment now at twenty twenty seven than it was in
• 18:45
  Speaker 1: twenty twenty four. I'm going to taper back my performance
• 18:50
  Speaker 1: expectations than we have historically. You know, of course, that's
• 18:53
  Speaker 1: your prerogative, that's your strategy. Maybe that's how you're balancing
• 18:57
  Speaker 1: your books within the other star measures that are a
• 18:59
  Speaker 1: focus in phys for years, but recognize that other health
• 19:02
  Speaker 1: plans may not be playing that same game. They may
• 19:05
  Speaker 1: be playing their MPTM program in a way that they've
• 19:08
  Speaker 1: developed a really high, high quality focus to their MPTM
• 19:12
  Speaker 1: program that's allowing them to see, you know, that total
• 19:16
  Speaker 1: cost of care value from their program and really support
• 19:19
  Speaker 1: an investment into the program that drives a much higher completion.
• 19:23
  Speaker 2: Rate of cmrs. Then maybe you're really focused on.
• 19:27
  Speaker 1: So I think that's going to be the important and
• 19:29
  Speaker 1: interesting part of this, Cindy, is you know, contemplating there's
• 19:33
  Speaker 1: a lot of different aspects to how twenty to twenty
• 19:38
  Speaker 1: seven will play out. As I mentioned, we've you know,
• 19:42
  Speaker 1: done our due diligence to predict out where we feel
• 19:46
  Speaker 1: like that's going to land. And we're looking forward to
• 19:48
  Speaker 1: supporting payers as they're strategizing in this space and really
• 19:53
  Speaker 1: building their own business cases within their own organizations around
• 19:57
  Speaker 1: you know, a robust program that can not only deliver
• 20:01
  Speaker 1: star rating success, but also total cost of care success
• 20:04
  Speaker 1: or name it whatever measuring stick you're bringing to the
• 20:07
  Speaker 1: MTM program. How can we help you articulate that measuring
• 20:09
  Speaker 1: stick accordingly so you can really you know, allow the
• 20:13
  Speaker 1: investment to be supported. So I think that's going to
• 20:17
  Speaker 1: be you know, parts of it, Cindy, is you know,
• 20:20
  Speaker 1: how do you how do you kind of put all
• 20:21
  Speaker 1: those puzzle pieces together as a health plan to really
• 20:24
  Speaker 1: make a picture at the end of the day that's
• 20:27
  Speaker 1: compelling for you and for your contract to perform.
• 20:31
  Speaker 2: So Ross, I.
• 20:32
  Speaker 3: Have two things as you were kind of talking about
• 20:36
  Speaker 3: that that I think would be really good to kind
• 20:41
  Speaker 3: of elaborate on. One is we talk about total cost
• 20:44
  Speaker 3: of care and the role that plays in total cost
• 20:47
  Speaker 3: of care, which I think is a goal and a
• 20:50
  Speaker 3: metric outside of stars alone. So when we talk about,
• 20:56
  Speaker 3: you know, how does CMR drive total cost of care
• 21:00
  Speaker 3: or drive you know, value based care delivery, can you
• 21:04
  Speaker 3: kind of talk about the factors there, you know, put
• 21:08
  Speaker 3: yourself in you know, an executive's position. How do CMR
• 21:14
  Speaker 3: control total cost of care? You know, outside of star
• 21:17
  Speaker 3: ratings and performance? And then I think the other thing
• 21:20
  Speaker 3: that you touched on that'll be really important is you
• 21:24
  Speaker 3: know what is like the one key thing is as
• 21:27
  Speaker 3: payers are looking at expanded denominators, what is the key
• 21:31
  Speaker 3: thing that they need to keep in mind as they're
• 21:33
  Speaker 3: planning ahead for you know, how are they going to
• 21:36
  Speaker 3: deploy these programs and scale these programs.
• 21:38
  Speaker 1: Yeah, I think that's a really great question, Cindy, just
• 21:41
  Speaker 1: from the standpoint of you know, sitting that in that
• 21:44
  Speaker 1: executive's chair and you know, as they look out onto
• 21:48
  Speaker 1: the landscape of the CMR completion rate in the coming
• 21:51
  Speaker 1: year as it returns to an active star measure, the
• 21:53
  Speaker 1: first thing that I always think about from the value
• 21:56
  Speaker 1: proposition of the CMR is just the multi fast the
• 22:00
  Speaker 1: nature of the CMR itself. You know, when you hear
• 22:03
  Speaker 1: one story of the value of a CMR, you've really
• 22:07
  Speaker 1: just heard one of those stories of the patient's experience
• 22:11
  Speaker 1: in that CMR. Right There is you know, potential to
• 22:15
  Speaker 1: improve adherence performance, there's a potential to reduce emergent care needs.
• 22:20
  Speaker 1: There there may just be an opportunity to strengthen a
• 22:23
  Speaker 1: local relationship between a pharmacist and a patient to really
• 22:26
  Speaker 1: understand that full and comprehensive medication regiment that the patient
• 22:31
  Speaker 1: is taking. And so by nature of that, it really
• 22:34
  Speaker 1: comes down to what are the strategic pillars of the
• 22:37
  Speaker 1: health plan is looking to improve and how can they
• 22:39
  Speaker 1: design their MTM program in a way that the CMR
• 22:42
  Speaker 1: can help to you know, accentuate and help to support
• 22:46
  Speaker 1: all of those different strategic pillars for the organization. So
• 22:50
  Speaker 1: I think I might turn the question right back on you,
• 22:52
  Speaker 1: Cindy for a minute. Given your background, I'd love to
• 22:56
  Speaker 1: put you into the executive role as well. What are
• 22:58
  Speaker 1: those first steps that you take given the news that
• 23:01
  Speaker 1: the CMR completion right is coming back.
• 23:04
  Speaker 2: I think.
• 23:06
  Speaker 3: The first thing to do is go back to projection modeling.
• 23:10
  Speaker 3: Make sure that you understand, you know, as the criteria
• 23:16
  Speaker 3: changes and we're expecting more members to fall into the denominator.
• 23:22
  Speaker 3: I do feel that you know understanding what that's going
• 23:26
  Speaker 3: to look like and what the scope of the scale is.
• 23:30
  Speaker 3: I think is one starting point, right. I think then
• 23:34
  Speaker 3: once you understand, you know what is what is the
• 23:37
  Speaker 3: need here, then you start to look at levers and
• 23:41
  Speaker 3: as a health plan, you look at what vendors do
• 23:43
  Speaker 3: I have relationships with? What campaigns am I deploying? You know,
• 23:48
  Speaker 3: how do I best leverage the staff I already have
• 23:51
  Speaker 3: and the relationships I have And obviously you know thinking
• 23:55
  Speaker 3: about the engagement factor, how do we keep folks engaged.
• 23:59
  Speaker 3: So you know, lots lots of different areas within the
• 24:03
  Speaker 3: health plan. Working together, I think on this is pretty important.
• 24:06
  Speaker 3: But understanding what that new demand is going to be
• 24:09
  Speaker 3: is critical for you know, for day one. Then we
• 24:13
  Speaker 3: start to work on how do I scale right? And
• 24:15
  Speaker 3: I think with what comes, you know, that's one of
• 24:19
  Speaker 3: the strongest areas for us is our ability to scale quickly.
• 24:23
  Speaker 3: And that also goes back to supporting the community pharmacies
• 24:28
  Speaker 3: that are part of our network as well and making
• 24:30
  Speaker 3: sure that we're bringing them opportunities to diversify their revenue
• 24:35
  Speaker 3: streams away from just dispensing.
• 24:37
  Speaker 2: And so that's yeah, I think that's a good point today. Yeah, yeah,
• 24:41
  Speaker 2: is the community pharmacies as well. And I know.
• 24:46
  Speaker 1: One of the very first questions that we're getting from
• 24:48
  Speaker 1: health plans is how are you helping those community pharmacies
• 24:51
  Speaker 1: to prepare for twenty seven?
• 24:54
  Speaker 2: Right given this news, So.
• 24:55
  Speaker 1: You know, briefly from that standpoint too, you know, how
• 25:00
  Speaker 1: are we helping those community pharmacies to prepare for twenty seven?
• 25:04
  Speaker 3: Well, Aros, as our CMR guru and CMR product owner,
• 25:10
  Speaker 3: I think you're probably the best person to kind of
• 25:13
  Speaker 3: talk about some of the things that we're looking at,
• 25:16
  Speaker 3: some of the areas that you've been researching as we
• 25:19
  Speaker 3: look to you're responding to this demand. So you know,
• 25:23
  Speaker 3: obviously I have an inside look on on a lot
• 25:26
  Speaker 3: of this, but I think, you know, maybe you can
• 25:28
  Speaker 3: kind of share some of the things that you've been
• 25:30
  Speaker 3: looking at and some of the direction that we're heading
• 25:32
  Speaker 3: for CMR.
• 25:34
  Speaker 2: Sure, turn it right back to me.
• 25:35
  Speaker 1: Yeah, you know, as you already alluded to, you know,
• 25:39
  Speaker 1: community pharmacy and the scalability of our nationwide network, but
• 25:44
  Speaker 1: also just recognizing the value of those local relationships as
• 25:48
  Speaker 1: they're engaging with their own patients and providing MTM services.
• 25:52
  Speaker 1: We know that that's really where you know, all of
• 25:55
  Speaker 1: these great stories really truly come from as their origin.
• 26:00
  Speaker 1: In terms of the value of CMR services, we also
• 26:03
  Speaker 1: recognize that a CMR at the end of the day,
• 26:06
  Speaker 1: if you look at the core definition of the service,
• 26:08
  Speaker 1: is something that is intended to empower patients, empower patients
• 26:13
  Speaker 1: to self manage their medications and health conditions. And again
• 26:18
  Speaker 1: I mentioned before a CMR and the value of the
• 26:20
  Speaker 1: CMR can be multifaceted, and that means that if you
• 26:24
  Speaker 1: have opportunities to sit and listen in and participate in
• 26:28
  Speaker 1: a comprehensive medication review. They all sound very different, and
• 26:32
  Speaker 1: that's because every patient is bringing their own health care
• 26:34
  Speaker 1: context to that conversation by.
• 26:36
  Speaker 2: Nature of that.
• 26:37
  Speaker 1: You know, as all the pharmacists listening into this podcast
• 26:41
  Speaker 1: will know. You know, you get near the holidays and
• 26:43
  Speaker 1: there's going to be conversation about the holidays. You get
• 26:46
  Speaker 1: near a birthday or an anniversary, there's going to be
• 26:48
  Speaker 1: conversations on those topics as well. So there is this
• 26:52
  Speaker 1: kind of core conversation that exists within a CMR regardless
• 26:57
  Speaker 1: of the complexity of the medication regimen that might come
• 27:00
  Speaker 1: into play. The you know, what the patient is bringing
• 27:05
  Speaker 1: to the table in terms of their knowledge of their
• 27:07
  Speaker 1: medication regimen. So there's that core amount of conversation and
• 27:11
  Speaker 1: time that's going to be happening, regardless of the profile
• 27:16
  Speaker 1: of the patient maybe that you're bringing into the CMR conversation.
• 27:20
  Speaker 1: At outcomes, we're really focused on how do we help
• 27:23
  Speaker 1: that core cord of the conversation continue to be such
• 27:27
  Speaker 1: an integral and valuable part of the CMR and then
• 27:30
  Speaker 1: remove the constraints the burden of additional documentation that might
• 27:37
  Speaker 1: be necessary surrounding that conversation. So really essentially, you know,
• 27:41
  Speaker 1: remove some of that documentation burden and allow the pharmacists
• 27:45
  Speaker 1: to really step in at another level with their clinical
• 27:49
  Speaker 1: knowledge and use that CMR as an opportunity to kind
• 27:52
  Speaker 1: of no longer be maybe required to curate data and instead,
• 27:57
  Speaker 1: you know, allow for opportunity to to spend time in
• 28:02
  Speaker 1: the clinical focus of the CMR. So that's a big
• 28:06
  Speaker 1: part to your point, Cindy, as we think about prepping
• 28:10
  Speaker 1: and helping pharmacies to really get ready for the return
• 28:15
  Speaker 1: of this measure is to give tools and reimagine what
• 28:21
  Speaker 1: our workflow looks like, what the journey of receiving a
• 28:24
  Speaker 1: CMR looks like, to ensure that patients can get the
• 28:29
  Speaker 1: best care possible and pharmacists have the most streamlined way
• 28:33
  Speaker 1: to do that and using the latest technologies to support
• 28:37
  Speaker 1: that is going to be a critical component. I mean,
• 28:41
  Speaker 1: you know this better than I do, Cindy, But you
• 28:43
  Speaker 1: look at all of the new innovation models that are
• 28:46
  Speaker 1: coming to the table from CMMI and just the industry
• 28:50
  Speaker 1: and how it's shifting with new technologies that are coming
• 28:54
  Speaker 1: to the forefront, and that is rightfully so allowing us
• 28:59
  Speaker 1: new ways is to think about care delivery. So I
• 29:02
  Speaker 1: think there's some exciting, Yeah, some exciting opportunities for us
• 29:05
  Speaker 1: to really continue to see the patient remain at the
• 29:09
  Speaker 1: center of that, and how do we help the pharmacy
• 29:12
  Speaker 1: to continue to wrap themselves around and support the patient
• 29:16
  Speaker 1: with those new capabilities new technologies. So it's going to
• 29:19
  Speaker 1: be an exciting time over twenty twenty six as we
• 29:21
  Speaker 1: look forward to twenty twenty seven.
• 29:23
  Speaker 3: Yeah, I was just thinking as you were kind of
• 29:25
  Speaker 3: talking through some of the ways that we're innovating and
• 29:29
  Speaker 3: sort of the challenges that we hear about, you know,
• 29:34
  Speaker 3: just thinking through so as we as we're looking for
• 29:39
  Speaker 3: increased efficiency in the in the CMR, I think there's
• 29:44
  Speaker 3: a couple things that are just realities that we can't shift.
• 29:47
  Speaker 3: One is that the population that is typically targeted for
• 29:51
  Speaker 3: a CMR are often isolated. So you know, when you
• 29:55
  Speaker 3: get that person on a phone who's genuinely interested, you
• 29:58
  Speaker 3: know that that is always going to be a reality,
• 30:01
  Speaker 3: and you want embrace that because you want to have
• 30:04
  Speaker 3: a great patient experience and to build that relationship which
• 30:10
  Speaker 3: can then be leveraged later for further engagement. Right right, Totally,
• 30:15
  Speaker 3: it's important right, Because if we're really talking about extending access,
• 30:20
  Speaker 3: leveraging our pharmacies, letting them practice at the top of
• 30:24
  Speaker 3: their license, you know, and inserting them where they really
• 30:29
  Speaker 3: should be, which is part of the care team. Really,
• 30:32
  Speaker 3: that requires a real close look at the realities of
• 30:36
  Speaker 3: the environment that they're working in, yes, and sort of
• 30:40
  Speaker 3: the hurdles that they face with doing this. And so
• 30:43
  Speaker 3: we hear about you know, wanting to have more predictability
• 30:48
  Speaker 3: around some of these services and also being able to
• 30:52
  Speaker 3: kind of have a better sense for how do I
• 30:56
  Speaker 3: appropriately staff this so that you know, I can make
• 30:58
  Speaker 3: sure to take advantage of.
• 31:00
  Speaker 2: These make the model work.
• 31:02
  Speaker 3: Yeah, so maybe you can talk a little bit more
• 31:05
  Speaker 3: in detail about some of the research that you've done
• 31:08
  Speaker 3: and what you've found as you've done some of that
• 31:10
  Speaker 3: research around, like heure, are the things that we feel
• 31:15
  Speaker 3: like we can solve for as we're thinking about solutionarydesign?
• 31:20
  Speaker 2: Yeah?
• 31:20
  Speaker 1: Yeah, thanks, Thanks Cndy. It's a really good question, and
• 31:23
  Speaker 1: I think, you know, it gets to the core of
• 31:27
  Speaker 1: how are we you know, in that preparation, what does
• 31:29
  Speaker 1: that actually look like and feel like for twenty twenty
• 31:33
  Speaker 1: seven And so interestingly enough, I think the themes from
• 31:38
  Speaker 1: from our continual research remain fairly constant and steady. So
• 31:44
  Speaker 1: you know, what I will share may not be groundbreaking
• 31:48
  Speaker 1: in nature, but it kind of reverberates in terms of
• 31:52
  Speaker 1: the sense that these are not they're not net new,
• 31:56
  Speaker 1: but they are foundational. And so you know, it's things
• 32:00
  Speaker 1: like to your point, predictability and helping to really understand
• 32:06
  Speaker 1: the work model that surrounds MTM program support at the
• 32:11
  Speaker 1: individual pharmacy level, at a maybe regional or district level,
• 32:16
  Speaker 1: at a full organization level. Right, those are all really
• 32:20
  Speaker 1: important components of not just a solid MTM program, but
• 32:24
  Speaker 1: really a solid clinical services program in totality within a
• 32:28
  Speaker 1: pharmacy setting. And then even within that, it's understanding the journey,
• 32:35
  Speaker 1: the workflow model of who does what as a part
• 32:38
  Speaker 1: of the CMR. So you'll see more from outcomes as
• 32:40
  Speaker 1: we're continuing to evolve the concepts of those roles. You know, today,
• 32:45
  Speaker 1: if you look at our Outcomes platform, you'll recognize it's
• 32:48
  Speaker 1: the same experience for all and we see that that's
• 32:50
  Speaker 1: a really great opportunity for us to help to better
• 32:53
  Speaker 1: support those individual roles as they're contributing in helping to
• 32:58
  Speaker 1: serve your patients. Those roles in other care settings result
• 33:03
  Speaker 1: in different experiences, and why not in the MTM space
• 33:08
  Speaker 1: as well. Right, So again these are themes that aren't
• 33:13
  Speaker 1: aren't groundbreaking per se, but I think the technology that
• 33:16
  Speaker 1: we can bring to the nationwide pharmacy network that we
• 33:21
  Speaker 1: have at scale is what gets me really excited to
• 33:24
  Speaker 1: see these capabilities really flourish and help pharmacies.
• 33:29
  Speaker 2: So I'm really really excited to be.
• 33:32
  Speaker 1: A part of, you know, some of the help we
• 33:35
  Speaker 1: can we can bring to the forefront of tools that
• 33:39
  Speaker 1: can you know, reduce some of that that workflow burden,
• 33:42
  Speaker 1: like you said, help pharmacists to practice at the top
• 33:45
  Speaker 1: of their license for example.
• 33:46
  Speaker 2: You know, we always say that as.
• 33:47
  Speaker 1: A as something we aspire to do, and I think
• 33:50
  Speaker 1: we're really excited in twenty twenty six to deploy new
• 33:54
  Speaker 1: capabilities to really to really show that in action. Well,
• 33:58
  Speaker 1: this has been fun to have conversation with you, Cindy.
• 34:01
  Speaker 1: Obviously there is plenty more that we'll be evolving over
• 34:05
  Speaker 1: the coming year, and we're really excited as outcomes to
• 34:08
  Speaker 1: bring updates as we progress forward. You know, the return
• 34:12
  Speaker 1: of the CMR completion rate, it's one of the most
• 34:14
  Speaker 1: important shifts in the star's landscape heading into measure year
• 34:17
  Speaker 1: twenty seven, and plans that act early rebuilding MTM capacity,
• 34:22
  Speaker 1: tightening workflows, aligning to predicted cutpoints, they'll be in the
• 34:26
  Speaker 1: best position when the twenty twenty nine Star writing cycle arrives.
• 34:30
  Speaker 1: So if you haven't already, jump over to Outcomes MTM
• 34:34
  Speaker 1: dot Com to read our blog post that contains the
• 34:37
  Speaker 1: cutpoint predictions that we've talked about here today. We've also
• 34:40
  Speaker 1: got some identification rate analysis in there, so it's definitely
• 34:44
  Speaker 1: an opportunity for you all to get the resources that
• 34:46
  Speaker 1: you need to support your preparation and those steps that
• 34:50
  Speaker 1: Cindy was alluding to of contemplating and doing the analysis
• 34:54
  Speaker 1: right now to really then identify what your strategic priorities
• 34:59
  Speaker 1: are for the remain and dare of twenty twenty six
• 35:01
  Speaker 1: as you prepare for twenty twenty seven. But for today,
• 35:04
  Speaker 1: thank you all for listening. We're committed to bringing you
• 35:06
  Speaker 1: the latest insights in healthcare innovation and strategy.
• 35:10
  Speaker 2: If you found this valuable, subscribes.
• 35:12
  Speaker 1: You don't miss our next episode.
• 35:13
  Speaker 2: Until then, stay curious