Title: The Value of Medication Therapy Management Services
1The Value of Medication Therapy Management
Services
2Purpose 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
3Definition 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
4MTMS 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
5The 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
6Components 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
7Medication 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
8MTM Pharmacist/Prescriber Relationship
9Pharmacists 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
10Medications 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
11APhA. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
12How 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 -
13Studies Illustrating Value of MTMS
- Asheville Project Diabetes
- Asheville Project Asthma
- Diabetes Ten City Challenge
- Minnesota Experience Project
14Asheville 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.
15Asheville 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.
16Clinical 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
17Asheville 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
18Average Annual Diabetic Sick-Leave Usage (City of
Asheville)
APhA. Pharmacists Improving Care and Reducing
Costs for Your Plan Participants. Available at
www.pharmacist.com
19Key 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.
20Asheville 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.
21Asheville 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.
22Economic Outcomes of MTMSThe Asheville Project -
Asthma
Bunting BA, Cranor CW. JAPhA. 2006 46133-147.
23Clinical Outcomes of MTMSThe Asheville Project -
Asthma
Improved Asthma control sustained over 5 years
Bunting BA, Cranor CW. JAPhA. 2006 46133-147.
American Pharmacists Association
24Key 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.
25Diabetes 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.
26Diabetes 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.
2710 City Challenge Economic Outcomes after Year 1
Fera T., Bluml BM, Ellis WM. JAPhA. 2009
49(3) 383-391.
2810 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.
29Key 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.
30Minnesota 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
31Minnesota 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
32Economic Outcomes from the Minnesota Experience
Project
33Clinical 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
34Key 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
35Limitations 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
36Summary 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.
37Elements of MTMS Plan Design
- Eligibility
- Reimbursement structure
- Member engagement strategy
- Incentives
38Reimbursement 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
39Whats 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
40Whats 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
41Summary
- 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