4/8/16

1

MTM  Medica)on  Therapy  Management  

Documenta)on  for  Pa)ent  Care  and  Payment  

Megan Jolley Milne, PharmD, BCACP Benjamin Jolley, PharmD Candidate 2018

Disclosures  

“I declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, and stock holdings.”

The Utah Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Learning  Objec)ves  

 At  the  conclusion  of  this  program,  the  par)cipa)ng  pharmacist  or  technician  will  be  able  to:  

 

•  List  three  vendors  that  u)lize  community  pharmacies  to  complete  MTM  interven)ons.  

•  Describe  three  different  ways  pharmacists  and  technicians  can  improve  a  pa)ent's  medica)on  therapy  and  how  much  they  can  expect  to  be  reimbursed  for  each  service.  

•  Iden)fy  pharmacy  workflow  situa)ons  in  which  MTM  can  be  u)lized  to  improve  pa)ent  care.  

Types  of  Reimbursable  MTM  

•  CMR:  Comprehensive  Medica)on  Review  •  TMR:  Targeted  Medica)on  Review  •  TIP:  Targeted  Interven)on  Program  •  Adherence  monitoring  •  Prescriber  consulta)on  

4

General  MTM  Steps  

•  Print  CMR  template  or  medica)on  list  – Verify  allergies  – Verify  medica)ons  listed  are  ac)ve  – Add  missing  medica)ons,  OTC,  vitamins  – Determine  the  purpose  for  each  medica)on  – Write  Sig  – Note  medica)on-­‐related  issues  

•  Finished:  Personal  Medica)on  List  (PML)  •  Print  and  mail  to  pa)ent:  leUer,  PML,  MAP  

5

CMS  Standardized  Format  

6

4/8/16

2

Medica)on  Ac)on  Plan  

•  Find  gaps  in  pa)ent’s  medica)on  therapy  

•  Write  ac)ons  the  pa)ent  can  take  

7

Medica)on  Ac)on  Plan  

Drug  Therapy  Problem  (DTP):  •  Medica)on-­‐related  problems  

•  Care  issues  to  resolve  •  Behaviors  to  encourage  

8

How  to  find  DTPs  

Ask  open-­‐ended  ques)ons:  •  What  concerns  do  you  have?  •  What  are  you  using  this  for?  •  How  are  you  taking  this?  •  When  do  you  take  this  medica)on?  •  Who  prescribed  it?  •  On  a  scale  of  1-­‐10,  how  much  do  you  think  this  medica)on  is  helping?  

9

Pa)ent  Documenta)on  

•  Health  literacy  •  Simple  vocabulary  •  Ac)onable  phrases  •  Write  in  pa)ent’s  perspec)ve  

10

Pa)ent  Documenta)on  

•  Health  literacy  •  Simple  vocabulary  words  •  Ac)onable  phrases  •  Write  in  pa)ent’s  perspec)ve  

11

BeUer  Documenta)on  

•  Write  in  pa)ent’s  perspec)ve:  

•  Get  my  cholesterol  checked.  •  Eat  more  vegetables  and  fruits.  

12

4/8/16

3

Physician  Communica)on  •  List  ac)on  items  

– Priori)ze:  keep  it  concise  – Limit  ac)on  items  

•  Support  with  relevant  clinical  guidelines  •  Format  to  enhance  simple  response  

– Fax-­‐back  prescrip)on  changes  •  Obsequiousness  

13

Example  Physician  LeUer  

•  Molina  Example  Text  here  

14

Ques)on:  

When  the  CMR  is  complete,  what  must  be  mailed  to  the  pa)ent  along  with  the  MAP  and  cover  leUer?  

a.  Comprehensive  medica)on  list  b.  Personal  medica)on  list  c.  Pa)ent  medica)on  list  d.  Targeted  medica)on  list  

15

Ques)on:  

When  the  CMR  is  complete,  what  must  be  mailed  to  the  pa)ent  along  with  the  MAP  and  cover  leUer?  

a.  Comprehensive  medica)on  list  b.   Personal  medica4on  list  c.  Pa)ent  medica)on  list  d.  Targeted  medica)on  list  

16

MTM  Pla`orms  

MedMonitor

17

Typical* Reimbursement Rates

MTM Type Mirixa OutcomesMTM

CMR $60-75 $50-60 DTP - $10-20

TMR $12 or $2 TIP: $20 Adherence Monitoring - $10 x4 + $40

Prescriber Consultation - $? Pharmacist-Initiated TIP

- $10?

18 *Rates depend on each Part D Plan Sponsor’s agreement.

4/8/16

4

Mirixa  Documenta)on  

•  Mirixa  TMR:  only  fill  out  the  informa)on  requested  in  the  “Alerts”  segment.  – Document  the  result  of  your  interven)on.    

•  Mirixa  CMR:  complete  full  clinical  segment.  – Allergies,  DTPs,  drugs,  sigs,  and  disease  states  – Mail  Standardized  Format:  leUer,  PML,  MAP  – Takes  20-­‐30  minutes  

19 CONFIDENTIAL © 2014 Mirixa Corporation

www.Mirixa.com

MirixaPro Platform Home Page Review

•  Case Summary – Lists all of the cases at your pharmacy within various status categories

•  Active Programs – Lists all of the active programs in which your pharmacy is contracted to participate

•  Training & Support – Provides links to training and support resources offered through the MirixaPro platform

•  Best Practice Resources – Provides insights and best practices offered by other pharmacists in Mirixa's network

•  What’s New – Offers news about the MirixaPro platform and programs offered by Mirixa, including links to Program Service Descriptions for current patient care programs

OutcomesMTM  

•  Slides  forthcoming  

21

Audience  Ques)on  

Which  MTM  pla`orm  will  allow  pharmacist-­‐ini)ated  claims?  a.  Alliance  MTM  b.  Mirixa  c.  OutcomesMTM  d.  PharmMD  

22

MTM  Payment  

Part  D   Admin  

Budget  

Overhead  

MTM  

In-­‐House  Pharmacist  

Third-­‐Party  MTM  

Pharmacy  Rx  Budget   Rx  

23

Enhanced  MTM  Model  

•  CMS  opened  the  MTM  innova)on  floodgates  •  Part  D  Plans  can  be  paid  for  innova)ve  MTM  solu)ons  

•  Non-­‐bid  $

24

4/8/16

5

Medicaid  States  with  MTM*  

25

Blue  =  state  with  MTM  legisla)on  *Not  a  comprehensive  list  

How  MTM  Pays  

•  MTM  Fee  •  Transfers  •  Refills  •  MedSync  •  Immuniza)ons  •  Front  end  •  OTC  •  DME  

26

•  Goodwill  •  Loyalty  •  Referrals  

– MD  – Caregivers  

Workflow  Op)miza)on  

•  Prescrip)on  drop-­‐off  •  Pick  up  •  MedSync  

27

Medica)on  Synchroniza)on  

28

U)lizing  Technicians  

•  MTM  Lead  Tech  •  Login  to  Mirixa,  Outcomes  frequently  •  Offer  CMRs  •  Scheduling  •  Reminder  calls  •  Gree)ng,  sea)ng,  prep  worksheet  •  Data  entry  

29

Par)cipa)on  Ques)on  

What  should  be  included  in  the  Personal  Medica)on  List?  a.  Vitamins  b.  Snake  Oil  c.  Prescrip)ons  d.  Samples  e.  All  of  the  above  

30

4/8/16

6

U)lizing  Technicians  

•  CMR  Offer  – Explain  MTM  – Need  to  bring  all  medica)ons  

•  “Clear  out  the  medicine  cabinet”  •  Including  herbal  supplements,  vitamins,  samples  •  Anything  non-­‐food!  

– Create  a  script,  use  a  modified  one  online  •  “What  )me  would  work  for  you  on  Friday?”    

31

Technician  Call  Training  Script  

•  Hello  Mr/Mrs.  _____________,  it  is  )me  for  your  annual  check  up  with  the  pharmacist.  

•  This  is  a  benefit  included  in  your  __________  Medicare  pharmacy  insurance  policy.  Would  2:00  p.m.  work  for  you  on  Tuesday?  

•  Avoid:  “Would  you  like  to  schedule  a  CMR?”  •  Overcome  resistance  

 hUp://www.btpharmacyconsul)ng.com/uploads/5/6/4/0/56407431/techniciancalltrainingscript.pdf  

32

U)lizing  Technicians  

•  MTM  Documenta)on  Organiza)on  •  Google  Calendar  •  Google  Docs  

– MTM  Policy  – Checklist  – Call  Script  

•  How  to  overcome  resistance  

– List  of  pa)ents  

33

Organiza)on  

Four  Paper  Files:  1.  Pa)ents  that  are  on  CMR  list  and  need  to  

schedule,  get  into  the  pharmacy  2.  Pa)ents  that  need  completed  documenta)on  3.  Pa)ents  you  are  doing  adherence  checks  in/

Med  Sync    4.  Prescriber  recommenda)ons  in  Follow-­‐up    hUp://www.btpharmacyconsul)ng.com  

34

Asheville  Project  

35

               pre  

               pre  

True  or  False?  

•  Medicare  Part  D  plans  must  reimburse  retail  pharmacists  to  perform  MTM  comprehensive  medica)on  reviews  for  pa)ents  in  their  pharmacy.    

36

4/8/16

7

MTM  Payment  Part  D   Admin  

Budget  

Overhead  

MTM  

In-­‐House  Pharmacist  

Third-­‐Party  MTM  

Pharmacy  Rx  Budget   Rx  

37

Part  B  

Provider  Legisla)on  Ini)a)ve  

38

Need  More  Informa)on?  

Megan  Jolley  Milne,  PharmD,  BCACP  meganrph@gmail.com  

 

Resources:  Mirixa  

hUp://www.mirixa.com    •  •  •  

OutcomesMTM  hUp://www.outcomesmtm.com    

•  •  •  

BT  Consul)ng  hUp://www.btpharmacyconsul)ng.com  

Need  More  Informa)on?  

Megan  Jolley  Milne,  PharmD,  BCACP  meganrph@gmail.com  

 

Resources:  Academy  of  Managed  Care  Pharmacy  hUp://www.amcp.org/MTMResources/    

•  •  •  

American  Pharmacists  Associa)on  MTM  Central  www.pharmacist.com/mtm  

www.pharmacistsprovidecare.com    •  •  •  

Center  for  Medicare  and  Medicaid  Services  hUp://www.cms.gov/Medicare/Prescrip)on-­‐Drug-­‐Coverage/

Prescrip)onDrugCovContra/MTM.html