MTM Quality Metrics & Outcome Assessment 5 — Questions and Answers
Question 1: A health plan wants to compare its MTM program performance to national benchmarks. The MOST appropriate benchmarking source for Part D star measures is:
- The Joint Commission Sentinel Event database
- CMS Part D Star Ratings Technical Notes and national percentile distributions (Correct answer)
- USP Medication Error Reporting Program
- FDA MedWatch adverse event database
Correct answer: CMS Part D Star Ratings Technical Notes and national percentile distributions
CMS publishes annual Part D Star Ratings Technical Notes with national cut points and percentile distributions used for plan-to-plan benchmarking.
Question 2: The ECHO model of pharmacy outcomes organizes outcomes into three domains. These are:
- Structure, Process, Outcome
- Economic, Clinical, Humanistic (Correct answer)
- Safety, Efficacy, Patient Satisfaction
- Access, Quality, Cost
Correct answer: Economic, Clinical, Humanistic
The ECHO model (Kozma et al., 1993) classifies pharmacy outcomes as Economic, Clinical, and Humanistic to provide a comprehensive evaluation framework.
Question 3: A pharmacist calculates a cost-effectiveness ratio for an MTM intervention as $12,000 per QALY gained. This figure is interpreted as:
- The total cost of running the MTM program for one year
- The incremental cost to gain one quality-adjusted life year compared to usual care (Correct answer)
- The annual savings generated per MTM patient enrolled
- The cost per patient achieving their medication adherence goal
Correct answer: The incremental cost to gain one quality-adjusted life year compared to usual care
An incremental cost-effectiveness ratio (ICER) expresses the additional cost required to gain one QALY relative to the comparator intervention.
Question 4: Under the CMS MTM program requirements, the minimum annual CMR completion rate that plans must target for eligible beneficiaries is:
- 25%
- 50%
- 75% (Correct answer)
- 90%
Correct answer: 75%
CMS requires Part D sponsors to offer CMRs to all eligible MTM beneficiaries and has set a 75% completion rate target in the Star Ratings framework.
Question 5: Which of the following correctly describes the difference between 'efficacy' and 'effectiveness' in MTM outcome assessment?
- Efficacy measures cost savings; effectiveness measures clinical improvement
- Efficacy is measured in controlled trials; effectiveness is measured in real-world practice (Correct answer)
- Efficacy applies to generic drugs; effectiveness applies to brand-name drugs
- Efficacy is a process measure; effectiveness is an outcome measure
Correct answer: Efficacy is measured in controlled trials; effectiveness is measured in real-world practice
Efficacy reflects performance under ideal, controlled conditions (clinical trials), while effectiveness reflects performance in real-world clinical practice.
Question 6: A quality improvement team uses a Pareto chart to prioritize MTM intervention targets. The Pareto principle suggests they should focus on the problems that:
- Affect the largest number of patients regardless of severity
- Account for roughly 80% of outcomes while representing 20% of problem categories (Correct answer)
- Have been documented in the literature as high-priority DTPs
- Can be resolved within the current budget cycle
Correct answer: Account for roughly 80% of outcomes while representing 20% of problem categories
The Pareto principle (80/20 rule) guides teams to focus on the vital few problem categories that produce the majority of negative outcomes.
Question 7: A pharmacist documents a 'therapeutic duplication' drug therapy problem for a patient taking both naproxen and ibuprofen. In quality metric reporting, resolving this DTP would MOST directly improve which measure?
- Medication adherence for diabetes medications
- Use of high-risk medications in older adults
- Drug therapy problem resolution rate and potentially NSAID overuse metrics (Correct answer)
- Comprehensive medication review documentation rate
Correct answer: Drug therapy problem resolution rate and potentially NSAID overuse metrics
Resolving a therapeutic duplication DTP improves DTP resolution rates and, for NSAIDs in elderly patients, may also improve high-risk medication metrics.
MTM Quality Metrics & Outcome Assessment 5
A health plan wants to compare its MTM program performance to national benchmarks.
The MOST appropriate benchmarking source for Part D star measures is: