Assessing Evidence for MTM Quality Measure Development: A Scoping Review

Why It Matters

Without robust evidence, a new MTM quality measure could misguide CMS incentives and provider behavior, limiting its impact on patient safety and cost containment.

Key Takeaways

• Only 27 studies met strict Part D MTM criteria.
• High risk of bias limits confidence in reported outcomes.
• Evidence heterogeneity prevents new quality measure endorsement.
• Most interventions were CMRs delivered by phone.
• GRADE assessment rated overall certainty as low.

Pulse Analysis

Medicare Part D’s medication therapy management (MTM) program has become a cornerstone of pharmacy‑driven care, with the Comprehensive Medication Review (CMR) and Targeted Medication Review (TMR) serving as primary interventions. CMS ties MTM performance to Star Ratings, encouraging plans to boost enrollment and completion rates. However, quality measurement traditionally focuses on quantity—how many beneficiaries receive a CMR—rather than the clinical value of those interactions, prompting stakeholders to seek evidence‑based metrics that reflect true health outcomes.

The recent scoping review highlights a fragmented evidence base. After screening 424 publications, only 27 studies aligned with strict Part D eligibility and beneficiary criteria, and just six demonstrated low risk of bias. Outcomes spanned medication safety, adherence, and cost metrics, yet directness and consistency were uniformly low. Variations in intervention delivery—often undefined or limited to telephone CMRs—combined with heterogeneous patient populations, produced mixed results that GRADE classified as low certainty. This methodological turbulence undermines confidence in linking MTM activities to measurable improvements, a prerequisite for credible quality measures.

For policymakers and plan sponsors, the findings signal a need for standardized MTM documentation and robust study designs. Leveraging health‑information‑technology platforms to capture detailed intervention data, employing propensity‑score matching, and aligning eligibility thresholds can enhance internal validity. Until such evidence matures, CMS should prioritize refining existing measures and supporting research that isolates the clinical impact of MTM, ensuring future metrics drive genuine value for beneficiaries and the health system.