TABLE 2.

Major Themes by Chronic Care Model Element

CCM Element	Major Themes	Early Maturity Level vs. Later Maturity Level
Organization of health care	MTM as core competence Belief/confidence in MTM process Lack of formal rewards Organizational goals External environment	Later Maturity Level practices were confident in MTM provided at their organization Later Maturity Level practices were split on emphasizing CMRs vs. TMRs; some didn’t schedule CMRs due to inefficiencies if patients did not show
Delivery system design	Formalization regarding: Use of support staff Training Patient engagement	Later Maturity Level practices had more formalized processes and support staff and were more likely to contribute to patient recruitment, documentation, and billing
Clinical information systems	Influence of external environment Strategies for efficiency Accuracy and availability of information	Early Maturity Level practices relied more on payer billing platforms for documentation
Clinical decision support	Design implications User approach	None noted; differences appeared to be influenced by individual participant experience with MTM
Self-management support	When present, barriers pertained to: Patient MTM provider Payer	Later Maturity Level practices emphasized challenges with CMS required formats for medication action plan and personal medication list Later Maturity Level practices had more robust follow-up procedures
Linkages to community resources	Underuse	Across all practices, community resources were underused due to lack of familiarity or because not perceived as part of MTM

CMR = comprehensive medication review; CMS = Centers for Medicare & Medicaid Services; MTM = medication therapy management; TMR = targeted medication review.