1. The Value of Medication Therapy Management Services

2. 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

3. 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:
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 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

4. 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:

5. 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:

6. 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

7. MTM Pharmacist/Prescriber Relationship

8. 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.

9. 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 ; 49(3):
Isetts, et al., J Am Pharm Assoc. 2008;48(2):
Bunting BA, Cranor CW. JAPhA ; 46:
Cranor CW, Bunting BA, Christensen DB. J Am Pharm Assoc. 2003;43:

10. 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

11. 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

12. 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