The Value of Medication Therapy Management Services - PowerPoint PPT Presentation

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The Value of Medication Therapy Management Services

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Title: The Value of Medication Therapy Management Services


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. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
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 patients other health care
    providers
  • .

Bluml BM. Definition of medication therapy
management development of professionwide
consensus. J Am Pharm Assoc. 20054556672
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. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
5
The Spectrum of Pharmacist-Provided MTMS
  • Comprehensive or Targeted Medication Therapy
    Reviews
  • Adherence Services
  • Based on the number and/or type of medications
  • Targeted Medication Intervention Programs
  • High-alert and/or high-cost medications
  • Targeted patient population (i.e. geriatrics,
    pediatrics)
  • Disease State Management
  • Interdisciplinary approach to achieve therapeutic
    goals
  • Example disease states Diabetes, Cholesterol,
    Asthma
  • Health and Wellness Services
  • Immunizations
  • Wellness screenings
  • Smoking cessation
  • Weight management

APhA. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
6
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. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
7
Medication Therapy Management Process
ASSESSMENT
? Evaluate appropriateness, effectiveness,
safety, and compliance with medications ?
Identify drug therapy problems

Practitioner
Patient

CARE PLAN
Experienced Decision Making
Medication Experience
? Resolve drug therapy problems ? Establish goals
of therapy ? Interventions
? Philosophy of Practice ? Social Obligation ?
Responsibility to identify, resolve, and
prevent drug therapy problems ?
Patient-centered approach ? Caring
? Todays wants and needs ? Responsibility to
participate in information sharing and
decision making
FOLLOW-UP
? Evaluate progress in meeting goals of therapy ?
Record actual patient outcomes ? Reassess new
problems
Therapeutic Relationship
8
MTM Pharmacist/Prescriber Relationship
9
Pharmacists Communication with other Health
Providers
  • MTM Pharmacists will communicate regularly with
    patients primary care provider, and other health
    care team members as appropriate
  • Describe assessment
  • Describe and rationalize recommendations for
    medication changes
  • Recommendations for follow-up

10
Medications 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

11
APhA. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
12
How do we define value?
  • Value on investment
  • Economic
  • Overall cost savings or cost
  • Clinical
  • Improvements in health outcomes
  • Humanistic
  • Patient satisfaction, improved quality of life,
    worker productivity
  •  

13
Studies Illustrating Value of MTMS
  • Asheville Project Diabetes
  • Asheville Project Asthma
  • Diabetes Ten City Challenge
  • Minnesota Experience Project

14
Asheville Project Diabetes
  • Evaluation of outcomes following community based
    provision of MTMS to patients with diabetes
    covered by a self-insured employer group
  • Longitudinal study with pre- and post- data
  • Participants were provided incentives including
    waiver of all copays for diabetes medications and
    supplies
  • 5 years of follow-up data
  • 187 participants entered the program, with 26
    continuing at 5 years

Cranor CW, Bunting BA, Christensen DB. J Am Pharm
Assoc. 20034317384.
15
Asheville Project Diabetes
  • Pharmacists performed the following as part of
    this study
  • Set and monitored treatment goals
  • Glucometer training
  • Adherence monitoring
  • Basic physical assessment, including foot exam,
  • blood pressure and weight
  • Diabetes education
  • Referral to other providers as needed

Cranor CW, Bunting BA, Christensen DB. J Am Pharm
Assoc. 20034317384.
16
Clinical Outcomes of MTMSThe Asheville Project -
Diabetes
Cranor CW, Bunting BA, Christensen DB. The
Asheville Project long-term clinical and
economic outcomes of a community pharmacy
diabetes care program. J Am Pharm Assoc.
20034317384.
American Pharmacists Association
17
Asheville Total Health Care Costs1
Cranor CW, Bunting BA, Christensen DB.. J Am
Pharm Assoc. 200343173-84.
APhA. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
18
Average Annual Diabetic Sick-Leave Usage (City of
Asheville)
APhA. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
19
Key Findings Asheville Diabetes
  • Economic benefit
  • Total health care costs for patients decreased
  • Prescription costs increased, but medical costs
    decreased
  • Clinical benefit
  • Significant improvement seen in A1C and LDL
  • Humanistic benefit
  • Decreased sick leave increased worker
    productivity

Cranor CW, Bunting BA, Christensen DB.. J Am
Pharm Assoc. 200343173-84.
20
Asheville Project Asthma
  • Evaluation of outcomes following community based
    provision of MTMS to patients with asthma covered
    by a self-insured employer group
  • Longitudinal study with pre- and post- data
  • Participants were provided incentives including
    waiver of all copays for asthma medications and
    supplies
  • 5 years of follow-up data
  • 207 participants entered the program

Bunting BA, Cranor CW. JAPhA. 2006 46133-147.
21
Asheville Project Asthma
  • Pharmacists served as care managers and met with
    subjects an average of every 3 months
  • Reviewed asthma action plans
  • Medication assessments of inhaler use
  • Assessment of inhaler technique
  • Review of symptoms and peak flow meter readings
  • Recommendations for treatment changes were sent
    to physician

Bunting BA, Cranor CW. JAPhA. 2006 46133-147.
22
Economic Outcomes of MTMSThe Asheville Project -
Asthma
Bunting BA, Cranor CW. JAPhA. 2006 46133-147.
23
Clinical Outcomes of MTMSThe Asheville Project -
Asthma
Improved Asthma control sustained over 5 years
Bunting BA, Cranor CW. JAPhA. 2006 46133-147.
American Pharmacists Association
24
Key Findings Asheville Asthma
  • Economic benefit
  • Decreased percentage of asthma patients requiring
    emergency and hospital care
  • Clinical benefit
  • Improved asthma control sustained over 5 years
  • (as evidenced by FEV1 measurements)

Bunting BA, Cranor CW. JAPhA. 2006 46133-147.
25
Diabetes Ten City Challenge
  • Employer-funded, collaborative health management
    program for diabetes using community-based
    pharmacists in 10 cities across the USA
  • Pharmacists were located in
  • Independent pharmacies
  • Chain pharmacies
  • Ambulatory care clinics
  • On-site workplace locations
  • Participants received waived co-pays for
    medications.
  • 573 patients participated

Fera T., Bluml BM, Ellis WM. JAPhA. 2009
49(3) 383-391.
26
Diabetes Ten City Challenge
  • Pharmacists performed the following as part of
    this study
  • Applied a prescribed process of care based on
    clinical assessments and progress to goals
  • Worked with patients to set individualized
    self-management goals
  • Recommended changes in therapy when appropriate

Fera T., Bluml BM, Ellis WM. JAPhA. 2009
49(3) 383-391.
27
10 City Challenge Economic Outcomes after Year 1
Fera T., Bluml BM, Ellis WM. JAPhA. 2009
49(3) 383-391.
28
10 City Challenge Clinical Outcomes after Year 1
HEDIS process measures for patients with diabetes
Fera T., Bluml BM, Ellis WM. JAPhA. 2009
49(3) 383-391.
29
Key Findings 10 City Challenge
  • Economic benefit
  • Total health care costs were less than predicted
  • Prescription costs increased, but overall health
    care
  • costs decreased
  • Clinical benefit
  • Increased percentage of patients meeting HEDIS
    process measurement goals for patients with
    diabetes

Fera T., Bluml BM, Ellis WM. JAPhA. 2009
49(3) 383-391.
30
Minnesota Experience Project
  • Evaluation of MTMS provided at 6 ambulatory care
    clinics over 1 year
  • 285 patients received MTMS
  • HEDIS goals for hypertension and dyslipidemia
    were evaluated
  • Study patients were required to have 1 of 12
    study conditions
  • Return on investment was calculated at 121

Isetts, et al., J Am Pharm Assoc.
200848(2)203-211
31
Minnesota Experience Project
  • Pharmacists in this study
  • Used a consistent and systematic patient care
    process
  • Established goals of therapy in collaboration
    with patients and primary care providers
  • Made recommendations for changes in therapy as
    appropriate

Isetts, et al., J Am Pharm Assoc.
200848(2)203-211
32
Economic Outcomes from the Minnesota Experience
Project
33
Clinical Outcomes from the Minnesota Experience
Project
HTN n 254 p0.03
Dyslipidemia n 254 P0.001
Isetts, et al., J Am Pharm Assoc.
200848(2)203-211
34
Key Findings Minnesota Experience Project
  • Economic benefit
  • A 121 return on investment was seen
  • Savings was seen in facilities costs
  • Per person per year costs decreased from 11,965
    to 8197
  • Clinical benefit
  • The MTM intervention group had a higher
    percentage of patients meeting HEDIS goals for
    hypertension and dyslipidemia

Isetts, et al., J Am Pharm Assoc.
200848(2)203-211
35
Limitations of Current Evidence
  • Most of the data comes from self-insured employer
    groups
  • Individual studies are small
  • Ten City Challenge was the largest with 573
    participants
  • Much of the evidence is focused on specific
    disease states

36
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. 200848(2)203-211 Bunting BA, Cranor CW.
JAPhA. 2006 46133-147. Cranor CW, Bunting BA,
Christensen DB. J Am Pharm Assoc. 200343173-84.
37
Elements of MTMS Plan Design
  • Eligibility
  • Reimbursement structure
  • Member engagement strategy
  • Incentives

38
Reimbursement Structure
  • Recommend utilizing the MTMS CPT billing codes
  • May use them as defined as time-based codes,
  • or use a cross-walk relative value scale

39
Whats 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

40
Whats 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

41
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
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