medication therapy management (mtm) now and in the future ...toolbox.opcpcc.com › ... › 09 ›...

2
Hospital or specialist Drug Info Medical Home Team and Primary Care EHR Any Patients w/ Transition Any Patients Medication Therapy Management (MTM) Now and in the Future What You Need To Know A range of services designed to optimize drug therapy and improve outcomes for patients 1 , including services from electronic analysis of claims to interpersonal counseling by pharmacists. What Medication Therapy Management (MTM) Is There are increasing expectations for clinicians to take charge more actively of medication management: both CMS’s Meaningful Use and Patient-Centered Medical Home recognition programs assess MTM functions. The potential for MTM to improve care is huge. One-third of all American adults take five or more drugs 2 . Both serious adverse events 3 in hospitals and avoidable hospital admissions and readmissions 4 are linked to inappropriate medication use—including drug interactions, untreated conditions, and inappropriate dosages. The focus on cost savings by health plans and Medicare can be either narrow—focused just on limiting the amount spent on drugs —or broad—focused on how the use of medications affects total costs including hospitalizations and ER visits. At the same time, newly available resources may help make MTM more effective and efficient: systematic processes to optimize medications from all prescribers to reach clinical goals of therapy (see back page); trained clinical pharmacists available to primary care teams, and the use of shared electronic records. What the Current MTM Landscape Looks Like Patients Targeted: All patients on medications, especially those who have had a transition in care. Goals: Meeting clinical therapy goals, avoiding medication errors and adverse events, improving quality of care, and controlling medical costs, all within the limited context of medications MTM Now: Medication Reconciliation in Primary Care, with Assistance from EHRs and Health Plans PC MH Patient-Centered Medical Home Functions within the Primary Care Practice Basic medication reconciliation at every relevant visit by primary care teams includes: Reviewing all Rx’s, OTCs, and supplements reported by patient Reviewing Rx’s reported by hospital or specialist if available Practicing good, comprehensive primary care Advanced medication review as required in external programs (Meaningful Use and Patient-Centered Medical Home (PCMH) recognition), includes: Exchanging electronic Rx data with other prescribers for each patient Using certified EHR with drug-drug and drug-allergy alerts Reconciling medications after each transition, such as from a hospital or specialist Functions of Health Plans Commercial health plans analyze data on Rx claims for potential problems and opportunities to reduce costs; they alert physicians and patients to potential drug interactions, duplicate drugs, underuse or overuse, dosing problems, and generic substitutions. Medicare Drug Plans track patients’ pharmaceutical claims and inform patients about the status of their coverage. CMS also requires that plans’ staff conduct a comprehensive medication review (CMR) annually with any patient who has drug costs above a set amount. CMS measures how consistently the drug plans conduct the reviews, which include: Assessing medication-related problems Developing a plan to resolve problems Advising the patient on medication use Medicaid has no similar requirements nationally, although some state Medicaid programs, such as Minnesota’s, have developed them. Research findings 5 : Claims-based medication management has shown an increase in the resolution of drug duplications and drug-drug interactions, and a decrease in medical errors Medication reconciliation reduces adverse drug events through monitoring all of a patient’s medications and identifying discrepancies 6 . This is of particular importance for patients in transition to or from another provider 4 , when they are vulnerable to medical errors, adverse drug events, and in some cases re-admission. CMR improves resolution of drug therapy problems (such as therapeutic duplication and using drugs on the Beers List), performance on certain related quality benchmarks, and patient satisfaction 7 .

Upload: others

Post on 24-Jun-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Medication Therapy Management (MTM) Now and in the Future ...toolbox.opcpcc.com › ... › 09 › MTMMI395100MHC_401_01_GD.pdf · 1. Medication Therapy Management in Pharmacy Practice

Hospital orspecialist Drug Info

Medical Home Teamand Primary Care

EHR

Any Patients w/Transition

Any Patients

Medication Therapy Management (MTM) Now and in the Future What You Need To Know

A range of services designed to optimize drug therapy and improve outcomes for patients1, including services from electronic analysis of claims to interpersonal counseling by pharmacists.

What Medication Therapy Management (MTM) Is

• There are increasing expectations for clinicians to take charge more actively of medication management: both CMS’s Meaningful Use and Patient-Centered Medical Home recognition programs assess MTM functions.

• The potential for MTM to improve care is huge. One-third of all American adults take five or more drugs2. Both serious adverse events3 in hospitals and avoidable hospital admissions and readmissions4 are linked to inappropriate medication use—including drug interactions, untreated conditions, and inappropriate dosages.

• The focus on cost savings by health plans and Medicare can be either narrow—focused just on limiting the amount spent on drugs —or broad—focused on how the use of medications affects total costs including hospitalizations and ER visits.

• At the same time, newly available resources may help make MTM more effective and efficient: systematic processes to optimize medications from all prescribers to reach clinical goals of therapy (see back page); trained clinical pharmacists available to primary care teams, and the use of shared electronic records.

What the Current MTM Landscape Looks Like

Patients Targeted: All patients on medications, especially those who have had a transition in care.

Goals: Meeting clinical therapy goals, avoiding medication errors and adverse events, improving quality of care, and controlling medical costs, all within the limited context of medications

MTM Now: Medication Reconciliation in Primary Care, with Assistance from EHRs and Health Plans

PCMHPatient-Centered Medical Home

Functions within the Primary Care Practice

Basic medication reconciliation at every relevant visit by primary care teams includes:

• Reviewing all Rx’s, OTCs, and supplements reported by patient

• Reviewing Rx’s reported by hospital or specialist if available

• Practicing good, comprehensive primary care

Advanced medication review as required in external programs (Meaningful Use and Patient-Centered Medical Home (PCMH) recognition), includes:

• Exchanging electronic Rx data with other prescribers for each patient

• Using certified EHR with drug-drug and drug-allergy alerts

• Reconciling medications after each transition, such as from a hospital or specialist

Functions of Health Plans

Commercial health plans analyze data on Rx claims for potential problems and opportunities to reduce costs; they alert physicians and patients to potential drug interactions, duplicate drugs, underuse or overuse, dosing problems, and generic substitutions.

Medicare Drug Plans track patients’ pharmaceutical claims and inform patients about the status of their coverage. CMS also requires that plans’ staff conduct a comprehensive medication review (CMR) annually with any patient who has drug costs above a set amount. CMS measures how consistently the drug plans conduct the reviews, which include:

• Assessing medication-related problems

• Developing a plan to resolve problems

• Advising the patient on medication use

Medicaid has no similar requirements nationally, although some state Medicaid programs, such as Minnesota’s, have developed them.

Research findings5: Claims-based medication management has shown an increase in the resolution of drug duplications and drug-drug interactions, and a decrease in medical errors Medication reconciliation reduces adverse drug events through monitoring all of a patient’s medications and identifying discrepancies6. This is of particular importance for patients in transition to or from another provider4, when they are vulnerable to medical errors, adverse drug events, and in some cases re-admission. CMR improves resolution of drug therapy problems (such as therapeutic duplication and using drugs on the Beers List), performance on certain related quality benchmarks, and patient satisfaction7.

Page 2: Medication Therapy Management (MTM) Now and in the Future ...toolbox.opcpcc.com › ... › 09 › MTMMI395100MHC_401_01_GD.pdf · 1. Medication Therapy Management in Pharmacy Practice

Other Prescribers(specialists, etc.)

Medical Home Teamand Primary Care

EHR

Patients withcomplex regimen

TrainedPharmacistClinical and Pharmacy

Patient Info

Patients Appropriate for CMM: Patients with complex medication regimens who are not meeting goals or are experiencing adverse effects,

Goals of CMM: • To engage patients in optimizing their medications, whether prescribed or OTC

• To use the most appropriate and safe medications to achieve the clinical goals of therapy

• To prevent and control disease, thus improving patient outcomes and lowering total healthcare costs including hospitalizations

• To make medical home teams more productive and potentially to better utilize pharmacists in addressing the workforce shortage in primary care.

How CMM Works: The primary care physician or a member of the medical home team seeks medication management services for a patient in order to achieve clinical goals and minimize adverse events. Optimally this requires a clinical pharmacist trained to work directly with patients, but other professionals including physicians can perform CMM. The professional may meet with the patient multiple times to:

• Assess the patient’s medication-related needs using complete clinical data

• Identify the patient’s medication-related problems

• Develop a care plan with individualized therapy goals and personalized interventions (in conjunction with the patient and the patient’s health care providers)

• Follow up to evaluate actual patient outcomes.

Research findings: CMM for targeted patients improves patient satisfaction, reduces disease and death, and lowers total health care costs. Regarding costs, CMM services have shown return on investment (ROI) as high as 12:1 with an average of 3:1 to 5:18. A surprising finding is that the two most common drug therapy problems in ambulatory settings are:

• additional drug therapy needed for preventive, synergistic, or palliative care

• drug doses that are too low to achieve therapeutic levels9.

Though critical and often cited, non-adherence is actually the third most common drug therapy problem.

How to integrate CMM into a practice: Though not a new service, CMM is used most often by large integrated systems that employ clinical pharmacists. Health plans traditionally have not reimbursed independent practices for CMM services, but this is changing. Health plans including Medicare now emphasize coordinated care through patient-centered medical homes (PCMHs) and accountable care organizations (ACOs). Of the 33 measures that CMS requires ACOs to report, 18 are affected by medication use. Some plans use a CPT code specifically for CMM, billed by either pharmacists or physicians. To add a pharmacist to the team, smaller practices may contact a hospital or pharmacy school. CMM allows pharmacists and physicians to counsel patients in person, by telephone, or through virtual clinic arrangements supported by IT systems8.

On basic MTM: Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model. https://www.accp.com/docs/positions/misc/CoreElements.pdf

A full description of CMM: The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. RESOURCE GUIDE, second edition, JUNE 2012. http://www.pcpcc.net/files/medmanagement.pdf accessed 10/26/12.

On the economics of pharmaceutical treatment: Role of Pharmaceuticals in Value-Based Healthcare: A Framework for Success. American Journal of Managed Care, vol. 8 no. 7.

1. Medication Therapy Management in Pharmacy Practice version 2.0, The American Pharmacists Association and The National Association of Chain Drug Stores Foundation, March 2008. 2. “The Opportunity for Comprehensive Medication Management”, Patient Centered Primary Care Collaborative. 3. “Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries” U.S. Dept. of Health and Human Services, Office of the Inspector General. November 2010. 4. Coleman EA et al, Posthospital Medication Discrepancies Prevalence and Contributing Factors, Arch Intern Med. 2005, 165 (16), p. 1842-1847 5. McKibbon KA et al, Enabling Medication Management through Health Information Technology. Evidence Report/Technology Assessment No. 201. AHRQ Publication No. 11-E008-EF, Rockville MD, April 2011 6. Ernst ME et al, Medication Discrepancies in an Outpatient Electronic Medical Record, AM J Health Syst Pharm, November 1, 2001, 58, p. 2072-2075 7. Exploratory Research on Medication Therapy Management, Centers for Medicare and Medicaid, July 8, 2008. 8. Integrating Comprehensive Medication Management to Optimize Patient Outcomes 2nd Edition, Patient Centered Primary Care Collaborative, June 2012 9. Isetts B, et al, Clinical and Economic Outcomes of MTM Services: The Minnesota Experience. J Am Pharm Association, March/April 2008, 48 (2) p. 203-211

MTM in the Future: Comprehensive Medication Management (CMM) with the Pharmacist On the Primary Care Team

Resources

References

Copyright © 2012 Boehringer Ingelheim Pharmaceuticals, Inc. All rights reserved. Printed in the U.S.A. (11/12) MI395100MHC