When quality measures are used for performance comparisons within national programs, they should meet the measure evaluation criteria of importance, feasibility, scientific acceptability and usability. To satisfy importance criterion, evidence should demonstrate that the process of care meaningfully affects the desired outcome. PQA upholds these established standards for performance measure development, including sufficient evidence of the impact of the process of care on the desired outcome.
Researchers at PQA reviewed evidence focusing on the impact on outcomes from the Medicare Part D MTM program or services such as comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs). Studies were included if they were published between 2006 and 2024 and were specific to the Part D MTM program. The outcomes reported in the literature were grouped into four medication-related outcomes or into non-medication-related outcomes. While evidence exists, the review published recently in The American Journal of Managed Care, found limitations in the evidence base and concluded that there is insufficient evidence to support a new outcome measure for the MTM program.
Data constraints often limit the ability of researchers to design studies in ideal ways, but there are approaches that can be leveraged to strengthen studies’ designs, like leveraging statistical matching techniques to create balanced groups at baseline. Another strategy is to replicate aspects of studies to create a larger evidence base. These approaches should be paired with detailed reporting of key methodological aspects such as sample and intervention details.
The PQA report, Advancing Medication Therapy Management Quality Measurement, describes several challenges to developing a new measure for the Part D MTM program. The report describes the current state of MTM which PQA staff assessed through an environment scan to inform a call to action outlining the opportunities and challenges that exist to assess and improve MTM quality. PQA has also convened stakeholders via an Advisory Group to continue the discussion and keep interested parties updated on efforts and progress.
To read more about the evidence review, go to The American Journal of Managed Care.
PQA has published a number of blogs on its work to advance MTM quality.