The Value of Medication Therapy Management Services

Purpose of Medication Therapy Management Services (MTMS) To optimize therapeutic outcomes To decrease the likelihood of adverse events To enhance patient understanding and adherence To reduce overall healthcare spending APHA slide The goal of MTM is to optimize therapeutic outcomes for patients. In other words – to make sure that patients are correctly following instructions, taking the appropriate medications and seeing the desired effect. MTM is largely focused on education to ensure that the patient understands the purpose and instructions for their medications, as well as why it is important to take them correctly. Another aim of MTMS, which is a big reason why Medicare is interested in these services, is to reduce overall health care spending. ASK THE AUDIENCE: What do you think happens to prescription costs when pharmacists get involved in managing patients’ therapies? Do drug costs go up or down? People usually think drug costs go down. By making sure that patients are on formulary medications, identifying duplicate therapies and recommending generics, pharmacists can bring drug costs down. But oftentimes drug costs will actually go up. ASK THE AUDIENCE: Why would this happen? POSSIBLE REASONS: COMPLIANCE AND PERSISTENCY – EX: STATIN OR HTN MEDS DC’D BY PATIENT DUE TO FEELING WORSE OR NOT FEELING ANY DIFFERENT; ADDITION OF THERAPY – EX: CORTICOSTEROID FOR ASTHMA IN A PT OVERUSING ALBUTEROL Understand, though, that by increasing compliance and adding necessary therapy, pharmacists can reduce OVERALL healthcare spending by reducing complications of disease (statin compliance reduces risk of atherosclerosis and heart attack) or by preventing emergency room visits and hospitalizations. American Pharmacists Association

Definition of MTMS Services provided by a pharmacist that improve treatment outcomes for individual patients A professional service to promote the safe and effective use of medications A way to provide better care for patients Promotes collaboration among the patient, the pharmacist, and the patient’s other health care providers . The first bullet is the consensus definition agreed to by 11 national pharmacy organizations. Abstract – Definition of MTMS Reference Bluml BM. Definition of medication therapy management: development of a profession wide consensus. J Am Pharm Assoc. 2005;45:566–72. Link to full text: http://japha.metapress.com/link.asp?id=bl8w38952u7w7255 Objective: To describe events leading to development of a professionwide consensus definition of medication therapy management (MTMS) and attendant programs and services and present the document (definition, services, and program requirements) resulting from the process. Data sources: Author's own knowledge and records of events. Summary: Following the late 2003 passage of the Medicare Prescription Drug Improvement and Modernization Act, the pharmacy profession had a need to act quickly to define MTMS so that a consensus definition would be available as regulations implementing the Medicare Part D benefit were being written. The American Pharmacists Association facilitated this process by convening a broad working group of members and other involved parties to draft a preliminary definition. The Pharmacy Practice Activity Classification was used to check elements of the definition for consistency with services being offered in a wide variety of settings. A professionwide stakeholders conference was then convened with representatives from each of 11 national pharmacy organizations. This group, following a daylong meeting in late May 2004 and several weeks of e-mail messages and conference calls, finalized the MTMS definition, which was then approved by the chief executive officers of all 11 groups. Conclusion: Through the extraordinary efforts of the numerous organizations and participants, the MTMS Services Definition is one that is applicable within diverse pharmacy practice segments, whose services are feasible for a majority of practitioners to implement, and whose elements are supported by a professionwide consortium of 11 national professional pharmacy organizations. This historic achievement is the first step on a journey to find the best ways to effectively deliver MTM services to patients. Bluml BM. Definition of medication therapy management: development of professionwide consensus. J Am Pharm Assoc. 2005;45:566–72

MTMS Activities Assess patients’ health status Devise medication treatment plan Select, modify and administer medications Review current medications and identify drug-related problems Communicate care to other providers Provide patient education Refer patients for broader disease management services APHA SLIDE Here is a list of various activities that could considered part of MTM. Which of these activities do pharmacists regularly provide? ANSWER: Many pharmacists conduct ALL of these activities on a daily basis. Remember – it is up to each plan to build their MTMS programs by selecting which activities they believe will provide the most benefit to patients. So what are plans doing currently? ( NEXT SLIDE) APhA. Pharmacists Improving Care and Reducing Costs for Your Plan Participants. Available at: www.pharmacist.com

Components of the MTMS Core Elements Service Model Medication Therapy Review (MTR) a review of all medications including prescription, nonprescription, herbal products, and other dietary supplements Personal Medication Record (PMR) Medication-Related Action Plan (MAP) for the patient Intervention and/or Referral Documentation and Follow-Up APHA SLIDE The MTM Core Elements Service Model is designed to promote efficiency, efficacy, and consistency of care. The components of the service model for MTM service delivery are noted here. (The Medication Therapy Review, Personal Medication Record, and Medication-Related Action Plan are described in the following slides.) APhA. Pharmacists Improving Care and Reducing Costs for Your Plan Participants. Available at: www.pharmacist.com

Medication Experience Experienced Decision Making Medication Therapy Management Process ASSESSMENT  Evaluate appropriateness, effectiveness, safety, and compliance with medications  Identify drug therapy problems Patient Practitioner CARE PLAN Medication Experience Experienced Decision Making  Resolve drug therapy problems  Establish goals of therapy  Interventions  Today’s wants and needs  Responsibility to participate in information sharing and decision making  Philosophy of Practice  Social Obligation  Responsibility to identify, resolve, and prevent drug therapy problems  Patient-centered approach  Caring FOLLOW-UP  Evaluate progress in meeting goals of therapy  Record actual patient outcomes  Reassess new problems Therapeutic Relationship

MTM Pharmacist/Prescriber Relationship

Medication Recommendations MTM pharmacists may make recommendations in several ways: Directly to the patient Over-the-counter changes, general adherence tips, managing side effects Through the prescriber Changes in prescription medications Directly to the patient under a collaborative practice agreements Allows pharmacists to make adjustments to prescription medications via protocol Emphasize that MTM pharmacists will be “taking action” and not just sending a passive letter to physicians.

Summary of evidence of Value of MTMS Economic Multiple studies have shown positive results on total health care costs, creating a positive return on investment Clinical Multiple studies have indicated improved in clinical outcomes, specifically in diabetes, asthma, hypertension and dyslipidemia Humanistic The Asheville project has demonstrated reduced employee sick days and increased productivity. Fera T., Bluml BM, Ellis WM. JAPhA. 2009; 49(3): 383-391. Isetts, et al., J Am Pharm Assoc. 2008;48(2):203-211 Bunting BA, Cranor CW. JAPhA. 2006; 46:133-147. Cranor CW, Bunting BA, Christensen DB. J Am Pharm Assoc. 2003;43:173-84.

What’s in it for the payer? MTMS results in decreased overall healthcare costs Prescription costs will likely increase, but this is compensated by an overall decrease in costs Pharmacists can provide MTMS as a member of the health care team and medical home model Increased member satisfaction Mechanisms for MTMS claims processing are well established through CPT codes

What’s in it for the patient? MTMS provides patients with improved health outcomes from optimizing medication use This includes decrease emergency department visits and hospitalizations Increased understanding of medications and disease management Improved quality of life

Summary Medications are a standard in the care of chronic diseases Pharmacist delivered Medication Therapy Management Services are well documented to decrease health care costs while increasing the quality of health care