In this episode, host Ross Frei, Senior Product Manager and resident MTM/CMR strategist, sits down with Cindy Henry, Director of Payer Products at Outcomes, to unpack one of the biggest changes hitting Medicare Advantage plans: CMS’s intent to return the CMR completion rate to the Star Ratings program beginning in measure year 2027.
Ross and Cindy explore how the industry reacted to the latest CMS Advance Notice, why the CMR measure’s return matters, and how MTM strategy has quietly shifted during its two‑year placement on the display page. Together, they outline the pressures plans are feeling—from shrinking margins to rising expectations around clinical quality—and the renewed focus on the value of medication therapy management, total cost of care, and local pharmacy engagement.
A key topic throughout the episode is the impact of CMS’s expanded MTM eligibility criteria, which significantly increases denominators for 2025 and beyond. Cindy explains how this shift forces payers to rethink scale, budget, ROI, and operational models, while Ross shares Outcomes’ cut‑point predictions and how performance is likely to redistribute once the measure becomes active again.
The conversation also highlights Outcomes’ strategy to support both health plans and community pharmacies as they prepare for 2027. Ross describes work underway to reduce documentation burden, streamline workflows, leverage new technology, and allow pharmacists to practice at the top of their license—ultimately helping MTM delivery scale without sacrificing quality.
By the end of the episode, the message is clear: Plans that begin modeling, staffing, vendor alignment, and workflow modernization now will be best positioned when Star Ratings recalibrate in 2029. Listeners are encouraged to explore Outcomes’ latest prediction models and analysis at outcomes.com.
