How to increase your MIPS score: Medication management

In 2015 Congress passed the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) and included in that legislation was a mandate to establish new Quality Payment Programs (QPP) for CMS.  As a result, Medicare established the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM).  Reimbursement is based on a composite performance scoring system that includes 4 categories:

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  • Quality
  • Resource Use (cost)
  • Clinical Practice Improvement Activities
  • Advancing Care Information ( meaningful use of certified eHR technology)

If you’re a part of a provider organization  participating in MIPS or APM then you know that new payment opportunities (and challenges) are in the offing. The key to maximizing reimbursement is understanding how best to prioritize the innumerable quality measures that comprise the unified scoring system.

Here’s the good news: medication management satisfies a large number of these quality measures!

Key to the MIPS score: medication management

Medication management has the potential to strengthen patient and family engagement, while promoting effective prevention and treatment by focusing on medication adherence, safety and affordability.  These are big ticket items when it comes to MIPS and APMs and part of CMS’s targeted goals for 2018.

Key medication measures include:

  1. Anti-depressant adherence over the course of a year for all newly diagnosed depression
  2. Achieving target HgbA1c in diabetics
  3. Aspirin use in patients with arrhythmia
  4. Statin use in patients with established cardiovascular disease

All signs point towards medication management as a key to improving quality measure scores.

5 critical strategies to improve medication related outcomes:

  1. Medication reconciliation
  2. Post-discharge medication reconciliation
  3. Improving medication adherence
  4. Enhanced medication therapy management
  5. Taper potentially inappropriate high-risk medications

For more information on quality measures being used right now, check out the CMS Measures Management System  (MMS) which provides a framework for developing and maintaining the quality measures used.

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Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.