The Value of Medication Therapy Management Services

Purpose of MTMS

• To optimize therapeutic outcomes • To decrease the likelihood of adverse events • To enhance patient understanding and adherence • To reduce overall healthcare spending American Pharmacists Association

Pharmacists’ Evolving Role

From Dispensing Services… …to a clinical service provider

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

• 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 American Pharmacists Association

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 American Pharmacists Association

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 American Pharmacists Association

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) American Pharmacists Association

Medication Therapy Management Process

Patient

ASSESSMENT

 Evaluate appropriateness, effectiveness,  safety, and compliance with medications Identify drug therapy problems Practitioner

CARE PLAN

   Resolve drug therapy problems Establish goals of therapy Interventions  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  Philosophy of Practice  Social Obligation  Responsibility to identify, resolve, and prevent drug therapy problems  Patient-centered approach  Caring

Therapeutic Relationship

MTM Pharmacist/Prescriber Relationship

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

• 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

American Pharmacists Association

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

• Asheville Project: Diabetes • Asheville Project: Asthma • Diabetes Ten City Challenge • Minnesota Experience Project

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

• 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

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

• 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)

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; 49e52-e60.

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 HEDIC – process measurement goals for patients with diabetes

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

• 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 $8197 • Clinical benefit – The MTM intervention group had a higher percentage of patients meeting HEDIS goals for hypertension and dyslipidemia

Summary of evidence of Value of MTMS

• Economical – 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.

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

• Three (3)

‘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?

• 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?

• 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

• 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 • High satisfaction rates among participants