The value of medication therapy management services
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The Value of Medication Therapy Management Services. 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.

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The Value of Medication Therapy Management Services

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The value of medication therapy management services

The Value of Medication Therapy Management Services


Purpose of medication therapy management services mtms

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


Pharmacists evolving role

Pharmacists’ Evolving Role

From Dispensing Services…

…to a clinical service provider


Definition of mtms

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

      .

Bluml BM. Definition of medication therapy management: development of professionwide consensus. J Am Pharm Assoc. 2005;45:566–72


Mtms activities

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


Components of the mtms core elements service model

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


Medication therapy reviews

Medication Therapy Reviews

  • A Medication Therapy Review

    (MTR) is provided at routine

    intervals by a pharmacist

    • Annual comprehensive MTR

    • Additional comprehensive MTRs

      as needed

  • Targeted MTR at any time to address new or ongoing medication-related problems

APhA. Pharmacists Improving Care and Reducing Costs for Your Plan Participants. Available at: www.pharmacist.com


What do patients get from care aligned with the mtms core elements model

What Do Patients Get From Care Aligned With the MTMS Core Elements Model?

A complete list of all

of their medications:

Personal Medication Record (PMR)

A guide for managing their medications and related conditions:

Medication-Related Action Plan (MAP)

APhA. Pharmacists Improving Care and Reducing Costs for Your Plan Participants. Available at: www.pharmacist.com


The value of medication therapy management services

Medication Therapy Management Process

ASSESSMENT

 Evaluate appropriateness, effectiveness, safety, and compliance with medications

 Identify drug therapy problems

Patient

Practitioner

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

 Today’s 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


Mtm pharmacist prescriber relationship

MTM Pharmacist/Prescriber Relationship


Pharmacist s communication with other health providers

Pharmacist’s Communication with other Health Providers

  • MTM Pharmacists will communicate regularly with patient’s primary care provider, and other health care team members as appropriate

    • Describe assessment

    • Describe and rationalize recommendations for medication changes

    • Recommendations for follow-up


Medications recommendations

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


The value of medication therapy management services

APhA. Pharmacists Improving Care and Reducing Costs for Your Plan Participants. Available at: www.pharmacist.com


How do we define value

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


Studies illustrating value of mtms

Studies Illustrating Value of MTMS

  • Asheville Project: Diabetes

  • Asheville Project: Asthma

  • Diabetes Ten City Challenge

  • Minnesota Experience Project


Asheville project diabetes

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. 2003;43:173–84.


Key findings asheville diabetes

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. 2003;43:173–84.


Asheville project asthma

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; 46:133-147.


Key findings asheville asthma

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; 46:133-147.


Diabetes ten city challenge

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.


Key findings 10 city challenge

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.


Minnesota experience project

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 12:1

Isetts, et al., J Am Pharm Assoc. 2008;48(2):203-211


Key findings minnesota experience project

Key Findings: Minnesota Experience Project

  • Economic benefit

    • A 12:1 return on investment was seen

    • Savings was seen in facilities costs

    • Per person per year costs decreased from $11,965 to $8,197

  • 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. 2008;48(2):203-211


Summary of evidence of value of mtms

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. 2008;48(2):203-211

Bunting BA, Cranor CW. JAPhA. 2006; 46:133-147.

Cranor CW, Bunting BA, Christensen DB. J Am Pharm Assoc. 2003;43:173-84.


Reimbursement structure

Reimbursement Structure

  • Recommend utilizing the MTMS CPT billing codes

  • May used them as defined as time based codes,

    or use a cross-walk relative value scale


Establishment of billing codes

Establishment of Billing Codes

  • Three ‘pharmacist only’ CPT professional service codes to bill third-party payers for MTM Services delivered face-to-face between a pharmacist and a patient

    • 99605 is to be used for a first-encounter service (up to

      15 minutes)

    • 99606 is to be used for a follow-up encounter with an established patient (up to 15 minutes)

    • 99607 may be used with either 99605 or 99606 to bill additional 15-minute increments.

  • Classified as Category 1 and became eligible for use January 1, 2008.

Beebe M, Dalton JA, Espronceda M, et. al. Current Procedural Terminology 2009. American Medical Association: Chicago, IL.


What s in it for the payer

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


What s in it for the patient

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


Summary

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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