Core Elements of Medication Therapy Management (MTM) Services’ Model Framework Anne Burns, RPh Group Director, Practice Development and Research American Pharmacists Association

Medication Therapy Management Services: A Consensus Definition Three inseparable elements: Primary Definition: services that optimize therapeutic outcomes… Professional Service Components: MTM encompasses a broad range of activities and responsibilities within a pharmacist’s scope of practice… Program Elements: MTM Programs shall include (core criteria for an MTM program)… Pass out a copy of the definition at this part of the presentation. The primary definition focuses on services delivered through a patient-pharmacist relationship that optimize therapeutic outcomes. The primary definition also indicates that Medication Therapy Management may or may not be conducted in conjunction with the dispensing of a drug product. The next two sections of the definition delineate the range of activities that comprise MTM services and describe the core components of an MTMS program. Refer to the MTMS definition for a complete list of items.

The Challenge of Defining MTMS Create a definition that is: Applicable to diverse pharmacy practice segments Feasible for a majority of practices to individually implement Supported by professional organizations to bolster efforts in lobbying for regulatory language APhA organized the Pharmacy Profession Stakeholders’ Conference on May 25, 2004. The goal of this conference was to draft a definition of MTMS that all pharmacy organizations could support. It was important that the definition was broad enough to define MTMS in any practice setting and for any payment model. Although creating a definition for MTMS was important for addressing Part D, it was also important that MTMS be translatable to private pay and state-based plans.

MTMS Endorsing Organizations Academy of Managed Care Pharmacy American Association of Colleges of Pharmacy American College of Apothecaries American College of Clinical Pharmacy American Pharmacists Association American Society of Consultant Pharmacists American Society of Health-System Pharmacists National Association of Boards of Pharmacy* National Association of Chain Drug Stores National Community Pharmacists Association National Council of State Association Executives *Organization policy does not allow NABP to take a position on payment issues. Representatives from all of these organizations participated in the development of the MTMS definition. A single communication containing the consensus definition with the signatures from all 11 national pharmacy organizations was transmitted to CMS. The hope was to influence CMS before the proposed rule was released.

MTM Model Core Elements in Community Pharmacy Uses the MTM Definition as the basis for developing core elements of an MTM service in community pharmacy Created by APhA and NACDS with the input of an advisory panel of community pharmacy practice leaders involved in MTM delivery February 8, 2005: MTM Advisory Panel meeting April 27, 2005: core elements finalized

Advisory Panel: Key MTM Model Concepts Applicable to all patients in need of MTM services Patient-centered – empower patient to self-manage medications Importance of collaboration with physicians and other health care providers Facilitate continuity of care Able to be delivered by large numbers of pharmacists Distinct from dispensing

Advisory Panel: What Aids in Successful MTM Delivery? Pharmacists have dedicated time to provide MTM services Significant outreach to educate patients and physicians about the value of MTM services Risk stratification models to determine patients who could benefit most from MTM services A consistent, efficient format for documentation of MTM services Outcomes measures to measure the impact of MTM services

MTM Model Core Elements Medication Therapy Review (MTR) Personal Medication Record (PMR) Medication Action Plan (MAP) Intervention and/or referral Documentation and follow-up The group proposes a baseline or core MTM service as a Medication Therapy Review—something I call a “Medi-Chek” or Medicine Check-up as the core service. Set up in a standardized system, this takes the traditional ‘brown bag’ review and makes it more systematic—providing the patient a ‘Personal Medication Record’ and the pharmacist with more information about all of the medications the patient is taking. This also gives us the opportunity to assess something that’s often missed---in addition to what the patient is taking, what are they missing? Should they be taking a calcium supplement? Or an ACE inhibitor? What types of pain relieving medication should they have on hand, if aspirin or ibuprofen isn’t a good idea.

MTM Model Core Elements: Medication Therapy Review Model core elements document advocates for: Annual Comprehensive Medication Therapy Review (MTR) designed to improve patients’ self-management of medications Targeted Medication Therapy Reviews (MTRs) to address new medication problems or for medication therapy monitoring follow-up

MTM Model Core Elements Personal Medication Record (PMR) – patient receives a PMR at the end of a comprehensive MTR Medication Action Plan (MAP) – patient-focused document containing information the patient can use to improve medication self-management

MTM Model Core Elements Intervention/referral – pharmacist intervenes to address medication-related problems or refers the patient to the appropriate health care provider Documentation/follow-up – pharmacist documents services in a manner appropriate for evaluating patient progress and billing and schedules a follow-up visit

Questions? Anne Burns 202-429-7522 aburns@aphanet.org