Rex W. Force, Pharm.D., BCPS, FCCPAssociate Dean for Clinical Research

ISU Division of Health Sciences

Characteristics of High Performing MTM

Programs

I have no relevant financial relationships or commercial interests to disclose in conjunction with this presentation

Disclosure

Describe the components of medication therapy management (MTM) programs

Discuss the needs of MTM programs and outcomes that have been documented for MTM delivery

Outline processes necessary for establishing MTM services

Identify performance metrics and quality outcomes for MTM programs

Objectives

Which of the following is a goal of MTM?A. Improve med

adherence and reduce adverse events

B. Improve pharmacist reimbursement

C. Increase Part D plan ratings on the CMS website

D. All of the above are goals of MTM

MTM is a patient-centric and comprehensive approach to improve medication use, reduce the risk of adverse events, and improve medication adherence.

Therefore, the programs include high-touch interventions to engage the beneficiary and their prescribers.

Required of Medicare Part D providers Is an opt-out program for beneficiaries

What is MTM?

Is designed to ensure that covered Part D drugs prescribed to targeted beneficiaries are appropriately used to optimize therapeutic outcomes through improved medication use;

Is designed to reduce the risk of adverse events, including adverse drug interactions;

May be furnished by a pharmacist or other qualified provider

What is MTM?

Why is MTM needed?N Engl J Med. 2003;348:2635-45.

At minimum 2 or 3 chronic conditions May target disease states, but if they do

must include at least 5 of the following: Alzheimer’s Disease; Chronic Heart Failure (CHF); Diabetes; Dyslipidemia; End-Stage Renal Disease (ESRD); Hypertension; Respiratory Disease (such as Asthma, COPD); Bone Disease-Arthritis (such as Osteoporosis,

Osteoarthritis, or Rheumatoid Arthritis); Mental Health (such as Depression,

Schizophrenia, Bipolar Disorder, etc.). Maximum threshold of 8 chronic medications Likely to incur drug costs of $3,017 in 2014

MTM Inclusion

Medication therapy review might consist of:

A. Gathering medication history

B. Assessing cultural or social issues that affect med use

C. Developing a plan for resolving drug-related problems

D. Educating the patient on appropriate med use and monitoring

E. All of the above

Interventions for both beneficiaries and prescribers.

An annual comprehensive medication review (CMR

The beneficiary's CMR must include an interactive, person-to-person, or telehealth consultation performed by a pharmacist or other qualified provider; and may result in a recommended medication action plan.

If a beneficiary is offered the annual CMR and is unable to accept the offer to participate, the pharmacist or other qualified provider may perform the CMR with the beneficiary's prescriber, caregiver, or other authorized individual.

Quarterly targeted medication reviews (TMRs) with follow-up interventions when necessary.

MTM Services

Medication therapy review (MTR)

Personal medication record (PMR)

Medication-related action plan (MAP)

Intervention and/or referral Documentation and follow-up

MTM Service Model

Sometimes called CMR, Comprehensive Med Review

Collection of patient-specific data Assessing therapy to identify drug-

related problems Prioritization Plan for resolution

Medication Therapy Review

Comprehensive record of patient’s: Medications – dose, indication,

instructions, start/stop dates, prescriber, etc.

OTCs Herbals Vitamins, minerals, and others

Should include provider info, allergies, pharmacy, patient info, etc.

Should help engage med self-management

Carry with patient at all times Date last updatedPersonal Medication

Record

Patient-centered document with list of actions related to self-management

Goal is to engage patient and encourage participation in therapy:

Checking med use and adherence, blood sugars, weights, blood pressure, dietary logs, functional status, etc.

Medication-related Action Plan

Address identified drug-related problems

Intervention and/or Referral Collaborate with other members of the

health care team Documentation

Enhance continuity Needed for billing Protect against liability Assists with documenting outcomes

Billing

Next Steps

JAPhA 2008;48:341-53

Establishing MTMhttp://pharmacist.com/implementing-mtm-your-practice

Billing NPI numbers CPT codes Requirements

Business development tools Business model

Measuring success Marketing and promotion

Establishing MTM

Getting Plugged Into MTM

Some companies act as go-between for pharmacists and Part D providers

Outcomes MTM Mirixa

Contracting directly with Part D providers

Commercial insurance Self-insured companies Direct-to-patient marketing

http://pharmacist.com/getting-your-mtm-business-started

MTM program from 2001-2 6 clinics in Minnesota with MTM

and 9 clinics without Measured: resolution of drug

therapy problems, attainment of HEDIS measures for hypertension and dyslipidemia

Outcomes of MTMJAPhA 2008;48(2);203-211.

637 drug-related problems in 285 patients addressed (2.2/patient)

33.9% needed add’l drug therapy 19.9% needed increased drug dose 14.1% had adverse effect 9.6% non-adherent with regimen

HEDIS measures for: BP improved, 71% v. 59% (p=0.03) Lipids improved, 52% v. 30%

(P=0.001) 31% reduction in total health care

costs for MTM patients ROI $12.15 per $1 spent on MTM

Outcomes of MTMJAPhA 2008;48(2);203-211.

Patient satisfaction with telephonic MTM

5-point Likert scale (5=strongly agree)

60 subjects received MTM and then surveys

80% survey response Overall mean satisfaction score

was 4.0 (+/-0.6) Happy with ability to contact

pharmacist, get questions answered, content with MTM over the phone (mean=4.3)

Less happy with referral for preventive services and other health care providers (mean=3.6)

Outcomes of MTMRes Soc Admin Phar 2010;6:143-54

Outcomes of MTM

Impact of MTM on mortality, hospitalization, ED use, daily Rx costs

Matched cohort study Received MTM between 2006-10 34,532 with MTM matched to 138,128

without Controlled for several variables Significant 14% reduction in mortality

in MTM group 3% reduction in hospitalizations

although ED visits increased in the MTM group

No difference in daily medication costs

AJMC 2014;20(2):e43-e51.

# Rx per day Generic conversions Labor costs/Rx Rx sales Customer satisfaction

Pharmacy Performance Measures - 2014

Patients adherent to med regimen

Achievement of therapeutic goals

Customer satisfaction – care directed

Pharmacists will (and should) be held accountable for contribution to outcomes

MTM Quality Measurements – 201?

Pharmacy Quality Alliance has created consensus-driven quality metrics

High risk meds in the elderly (modified Beers’ list)

Appropriate treatment of HTN in persons with diabetes

Proportion of days covered ACE/ARB Statins Oral diabetes meds

It is expected that CMS will continue to adopt PQA Measures

CMS Has Adopted PQA Measures

{

• From APhA – Core Elements • Pharmacist Services Technical

Advisory Coalition – www.pstac.org

• National provider number: https://nppes.cms.hhs.gov

• Pharmacy Quality Alliance: http://www. Pqaalliance.org

Resources

MTM programs represent a significant tool to improve health

The ROI is positive and other health benefits have been documented

Part D plans are evaluated on quality metrics that may be influenced by MTM – pharmacists will also likely be held accountable – Medicare is paying the bill!

Pharmacists can embrace the opportunity to make a difference with MTM

Summary

Companies like Mirixa and Outcomes MTM:A. Provide MTM

services directly to patients

B. Act as Part D providers

C. Act as middle men to distribute MTM patients to pharmacists for Part D providers

D. Offer NPI numbers to pharmacists

Which of the following is true?A. Patients have not

been shown to be satisfied with telephonic MTM services

B. The ROI associated with MTM services is insignificant

C. A large study demonstrated a survival benefit with MTM services

D. None of the above are true

Quality measures related to MTM and Part D drug programs deal with:A. Adherence to

regimensB. Proper evidence-

based pharmacotherapy

C. Safe medication use

D. All of the above