2. PHARMACY 2012: ADDING VALUE TO THE HEALTHCARE SYSTEM
MTM Organization 2

3. MICHAEL WOLNERMAN, RPh, CCIM
Dick Pharmacy, Des Moines, Iowa
Osco Drug, Chicago, Illinois
(Commercial Real Estate Gig)
Urbandale Pharmacy, Urbandale, IA
Franklin Pharmacy, Des Moines, IA
Your-Med LTC, Des Moines, IA
Walgreens, Des Moines, IA
Education: Drake University

4. DR. MICHAEL CASE HAUB, PHARMD
Hy-Vee Pharmacy, WDM, Cedar Rapids
CVS Pharmacy, New York, NY
Iowa Health System
Iowa Methodist Hospital
Department of Clinical Research
Penn Medical Pharmacy
Iowa Medicaid PA Department
Adjunct Faculty: Drake & University of Iowa
Education: Drake University
PharmD
BC-ADM (Board Certified- Advanced Diabetes Mgmt)

5. Outcomes Company Background
Who: Founded by Iowa pharmacists
What: Medication Therapy Management
Services (MTMS)
Outcomes MTM Program
Outcomes Targeted Intervention Program (TIP®)
When: January 1999
Where: Des Moines, IA
Why: Deliver a scalable, Face-to-Face MTM program that improves quality of care and lowers health care costs.
MTM Organization 5

6. MTM Opportunities Expand Exponentially
Outcomes Program Progression
Researching pharmacist-delivered MTM services and the effects on total health care costs
Congresses passes Medicare Modernization Act (MMA)
2010 Call Letter Released
MTM Opportunities Expand Exponentially
15K
1 million
2.5 million
5.5 million
1990s
1999
2003
2006
2009
2010
2011
200K
1.5 million
3.7 million
Outcomes Pharmaceutical Health Care ® Established
Medicare Part D Implementation
Significant MTM Changes Required

8. Client Types Payors Health Plans, Employers, Medicaid
PBMs/Claims Processors
Outcomes Management Options
Fully outsourced – Network delivery
Combination Client’s Internal RPhs + Network
Geographic Distribution
State, Regional, National
Size
One to 1.5 million covered lives

9. Types of Pharmacists: BS Pharmacy or Pharm D Retail/Pharmacy Sales
Hospital
Mail Order
Clinical
Nuclear
LTC/Chemotherapy

10. Pharmacist/Patient/Prescriber
Role of Pharmacist has not changed, it has expanded.
Role of the Patient has not changed, well, maybe??!!
Prescribers HAVE changed.
Pharmacist Complete the Triangle

11. Jerry Seinfeld Episode

12. How Does A Pharmacy Make Money? Groomed for the Pharmacy of Today:
Inventory Management
Prescription Volume
Customer Service
POS: Point of Sale
Vaccines
Locale of Pharmacy

13. Role Of A Pharmacist In Today’s Setting
MTM Organization 13

14. The Role: Transition from dispensing model
Fee for service is “dead”, pay for performance is new model
Medication Therapy Experts
Change in physician centric model

15. How Does this Affect Plans:
HEDIS measures
Star Ratings
Reimbursement
Bonuses
Patient recruitment
Pharmacist can positively effect vast majority of these measures

16. Services Provided: Medication Therapy Management
Disease state management
Transition of care/med reconciliation
Medical Home Model

17. How Is There Enough Time In The Day?
Current model= there isn’t time!
Current compensation paradigm= not self sustaining
Pharmacist filling more RXs
Efficiency/workflow

18. Prioritization Of Responsibilities
Utilization of Technology
Delegation certified technicians
Less focus technical functions, increase on cognitive services
Similar to physician clinic model

19. Medication Therapy Management In Today’s Pharmacy
MTM Organization 19

20. What is Medication Therapy Management (MTM)?
Leveraging Pharmacists to address therapy gaps and non-adherence, enhance quality and manage costs.

21. Real World Patient Example:
“Gertrude”
Diabetes, elderly, HTN
No ACEI/ARB
Recommendation to physician
“SHUT UP”; “MAKE ME”
Dialysis within 6 months
Documentation of recommendation
Out of court settlement
Could have been avoided!!

22. How Does An Outcomes MTM Program Work?
National footprint
50 states, Washington D.C. and Puerto Rico
Manages 60,000 Pharmacists through “MTM Centers”

23. Outcomes MTM Covered Services

24. Targeted Intervention Program (TIP)
Rx/Medical Data
Eligibility Data
TIP Engine (Clinical Rules)
TIP Quality Assurance
TIPs Uploaded Online
TIPs Mailed to Pharmacies

25. Online Claim Documentation Documented Savings to the Client
Push AND Pull Claims
Online Claim Documentation
Documented Savings to the Client
Client Outcomes Pharmacies $ $

26. Typical MTM Program Results
MTM Organization 26

27. The Program: 60,000 Commercial Lives in Iowa (2010 Data)
$4.2M in saved or avoided costs documented by community pharmacists
$1.2M of those savings are accounted for in drug product costs alone
$2.44 ROI on prescription drug spend alone
528 Pharmacies participated finding on average $783 in savings per patient served

28. Questions? Michael Wolnerman, RPh, CCIM
Dr. Mike Case Haub, RPh, PHARM D