The Value of The Value of Medication Therapy Medication Therapy

Management Management ServicesServices

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

American Pharmacists Association

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

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

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

Evaluate appropriateness, effectiveness, safety, and compliance with medications

Identify drug therapy problems

Experienced Decision M

aking

PractitionerM

edic

atio

n Ex

perie

nce Patient

Therapeutic Relationship

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

ASSESSMENT

CARE PLAN Resolve drug therapy problems Establish goals of therapy Interventions

FOLLOW-UP Evaluate progress in meeting goals of

therapy Record actual patient outcomes Reassess new problems

Medication Therapy Management Process

MTM Pharmacist/Prescriber

Relationship

Medication 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

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):203-211Bunting BA, Cranor CW. JAPhA. 2006; 46:133-147..

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

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