Transcript University of Florida Medication Therapy Management

A Patient Care
Business:
Communications
That Make a
Difference
University of Florida College of Pharmacy
Medication Therapy Management
Communication and Care Center
Objectives
 Introduce the University of Florida Medication Therapy
Management Communication and Care Center (MTMCCC)
 Describe the experience and expertise of the MTMCCC
 Contracts, pilots, and projects
 Managed care
 Long term care
 Staff credentials
 Discuss the MTMCCC approach and process with long term care
facilities
 Identify successes of MTMCCC’s services to health plans
2
UF MTM
Communication and Care Center
Our Self-Funded business model includes:

Multiple call center locations

Gainesville (Established 2010)

Lake Nona (Established 2012)

Flexible staffing

Adaptability

Continuous quality monitoring & performance improvement

Academic and research resources

Expertise and Experience

Conducted over 12,000 Comprehensive Medication Reviews & 35,000 Quarterly Reviews

Conducted over 300,000 live adherence calls in 2013

Projected over 600,000 live adherence calls for 2014
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Current Clients
-MTM Since Mar. 2010, Auto-Renewal
-Adherence Improvement Services Since Aug 2012
-MTM for MEDsAD Population, 3-Year Pilot Study Since 2011
-Extended for 1 additional year to 2015
-Adherence Services Since August 2013
-MTM and HEDIS Measure Improvement - August 2014
-MTM for UF Health Non-Tuberculosis Mycobacterial Clinic
Partnership with UF Clinic - Sept. 2013
-Quasi Endowment Funds Pilot Project (February-July 2014)
Patient-Centric, Telephonic MTM Services Post-Discharge to Reduce
Hospital Readmissions
Adherence Improvement Services - May 2014
-Coordination of care with case management team and providers
-MTM and HEDIS Measure Improvement – November 2014
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Our Average Patient
 65 years old
 Low health literacy
 Limited resources and travel
 Poor care
 Medical conditions: 10
 Prescription medications: 15
 Over-the-counter (OTC) and/or herbal medications: 5
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Our Team
Clinical
MTM
Pharmacists
Technology
Team
UF Faculty
Patient
Care
Pharmacy
Residents
Clinical
Associates
Student
Pharmacists
6
Our Staff Expertise

Pharmacists:

Managed care experience

MTM certificate program

Board certified ambulatory care pharmacy (BCACP)

Board certified psychiatric pharmacy (BCPP)

Consultant pharmacy licensure (CPh)

Certified geriatric pharmacists (CGP)

Pain and palliative care experience

Community pharmacy experience

Licensed practical nurse (LPN)

Registered/certified pharmacy technicians (RPhT/CPhT)

Licensed community health worker collaboration (LCHW)

Case management collaboration
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What Services Are We Providing?
 MTM Services
 Comprehensive Medication Reviews
 Quarterly reviews
 Adherence Services
 Prescriber Outreach Services
 Focusing on care coordination & quality improvement (QI)
8
What is Medication Therapy
Management (MTM)?
 A patient-specific & individualized service
 Typically for higher risk population
 Goal: To optimize therapeutic outcomes to improve overall
patient health
 Assesses all aspects of a patient’s medication-related care
 In collaboration with other health care providers
 Establish continuity of care
 No “gold standard” practice model
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Framework of MTM
 Established by collaboration of 11 national
pharmacy organizations
 The Five (5) Core Elements:
1.
2.
3.
4.
5.
Medication Therapy Review (MTR/CMR)
Personal Medication Record (PMR)
Medication-related Action Plan (MAP)
Intervention and/or Referral
Documentation with Follow-up
American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication therapy management in
Pharmacy Practice (Version 2.0). 2008. Available online at: www.accp.com/docs/positions/misc/coreelements.pdf
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Medication Therapy Review
 AKA: COMPREHENSIVE MEDICATION REVIEW (CMR)
 Live & Interactive
 In person or via tele-health
 Review of all:
 Prescription medications
 Over-the-counter products
 Vitamins, herbals, homeopathic
 Anything and everything else
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Medication Therapy Review
 Assess medication related problems and opportunities:
 Drug-drug interactions
 Drug-disease interactions
 Non-adherence issues
 Gaps in therapy:
 Medications missing indications
 Indications missing medications
 Duplications of therapy
 Adverse reactions
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Medication Therapy Review
 Inappropriate dosing:
 Too low/too high
 Opioid overutilization
 Inappropriate medications in the elderly (Beer’s criteria)
 Immunizations
 Alternative therapies
 Less costly medications
 Combination therapy
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Personalized Medication List
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Medication Action Plan
 Patient action item documentation
 Promotes medication and disease self management
 Collaborative effort between patient and pharmacist
 Written reminders
 Written in patient-friendly language (4th grade reading
level)
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Medication Action Plan
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Intervention and Referral
 Prescriber Interventions:
 Potential medication related problems
 Medication related opportunities
 Patient reported concerns and issues
 Referral sources:
 Social and economic assistance
 Crisis intervention
 Dietary needs
 Other providers: behavioral health, dental, physical therapy,
etc
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Intervention Example
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Documentation and Follow-Up
 Record of services for:
 Continuity of care
 Follow and monitoring of outcomes
 Billing and reimbursement
 Documentation systems:
 UF MTM platform
 Components:
 Record actions and outcomes
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Our General Practice Model
Clinical Associate
outreach to patient
CMR completed
with patient via
phone
Documentation
Follow-Up
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Long-Term Care (LTC) Process
 LTC member determined “interviewable” by obtaining
MDS 3.0 scores
 C0500
 B0700
 B0800
 Scores can be obtained via phone or fax.
 If interviewable  CMR with member
 If NOT interviewable  CMR with POA/Caregiver
 If POA or caregiver not available, attempt CMR with nursing
staff or consultant pharmacist at facility
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Clinical Focus for LTC
 Disease state management
 Identification of polypharmacy
 Prescribing cascade
 Detection of adverse drug reactions; medication overuse/underuse.
 Evaluation of drug interactions
 Identification of high risk medications in the elderly
 Beer’s List medications
 Fall prevention
 Sedative/ hypnotic initiatives
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Adherence Services
• Program Enrollment
Level 1 • Live Interactive Reminder Calls
• Assessment of Barriers with Patient-Specific
Level 2 Interventions
Level 3
Level 4
• Interactive Follow-Up Reviews
• Pharmacist Interventions for High-Level Needs
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Outreach Projects
 Target patient and/or prescriber to improve
quality measure performance
Patient Safety
Measures
• High Risk Medications
• Diabetes Treatment
Measure
HEDIS/Care Measures
•
•
•
•
•
Cardiovascular Care
Diabetes Care
Osteoporosis Management
RA Management
Antidepressant Med
Management
Other
• Reducing Hospital
Readmissions
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Outcomes From UF Projects
 MEDS-AD Demonstration Project

MTM services provided to MEDS-AD patients over 4 years

MEDS-AD Waiver Medication Therapy Management (MTM) Program Interim Report by FSU
College of Medicine/Social Work

Describes the quantitative/qualitative evaluation and preliminary findings
Table 2: Global Evaluation of the MEDS-AD Demonstration Project
Very
Poor
N(%)
How would you rate the overall care that you
experienced with the medication program?
0(0)
Poor
Fair
Good
N(%)
N(%)
N(%)
0(0)
0(0)
7(33)
Very
Good
N(%)
14(67)
 The gold standard of satisfaction lies in the interviews with participants themselves, it
became evident to the interviewers “that the commitment on the part of the UF COP
staff to patient well-being transcended the limitations of the MEDS-AD
Demonstration project while maintaining the integrity of the MTM process”
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Outcomes From UF Projects
 MEDS-AD Demonstration Project (continued)
 UF COP staff also noted as performing tasks often
defined as medical social services.
 Examples of these services included:
 Identifying transportation services from Tampa to
Orlando to aid a patient in obtaining services from the
only pain specialist who accepted patients with
Medicaid.
 Providing information on Medicaid coverage for nonmedication services such as environmental counseling
for patients with diagnoses of asthma.
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Pharmacist Recommendations
During Year One
Number of Interventions or
Resolutions
45
40
35
30
25
20
15
10
5
0
CostEffective
Option
Excessive Pill
Burden
Gap in
Therapy
Medication
Related
Problem
MISC
Potential
Overuse
Potential
Underuse
Interventions
8
16
22
36
7
11
39
Resolutions
5
3
4
17
1
6
14
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Transition of Care Pilot Program
 UF Health MTM Readmission Pilot Program
 Provided patient-centric telephonic follow-up after hospital
discharge
 314 comprehensive medication reviews performed
 Results: pharmacist interventions
 Total interventions via facsimile = 189
 Total CMRs with intervention via facsimile = 112 (35.7 % of total
CMRs completed)



CMRs with 1 intervention = 65
CMRs with 2 interventions = 27
CMRs with > 2 interventions = 20
 Medication list discrepancies
 Total number of discrepancies identified = 823
 Represented 78.34% of CMRs completed
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Items Identified During Pilot
Program
 UF Health MTM Readmission Pilot Program (continued)
Suboptimal Pain Refill Request
Regimen
2%
2%
Dosing
Discrepency
4%
Reduction in Pill
Burden
2%
Adverse Event
4%
NonAdherence
7%
Lack of Efficacy
1%
Diabetes: Lack of
ACEI/ARB
16%
Potential Gap in
Therapy
49%
Excessive use of
SABA
2%
Drug- Drug
Interaction
16%
Drug-Disease
Interaction Drug-Age
2%
Interaction
3%
Asthma/COPD: Lack
of Controller
3%
1%
Excessive
Medication
Dosage or Use
3%
Duplication of
Therapy
3%
Asthma/COPD: Lack
of Rescue
A.Fib: No
3%
Anticoagulation
Other
2%
Indication
ACS/CAD: Lack of
9%
Statin
ACS/CAD: Lack of
Fast Acting Nitrate
19%
ACS/CAD: Lack of
Beta Blocker
3%
Long Term Steroid
Use: Lack of Osteoporosis: Lack
Antiresorptive of Antiresorptive
10%
4%
Diabetes: Lack of
Statin
11%
Heart Failure:
Suboptimal Beta
Blocker
12%
Heart Failure: Lack of
ACEI/ARB
5%
Heart Failure: Lack of
Beta Blocker
2%
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New Medicaid Pilot Project
 Managed Medicaid Plan: November 2014
 Targeted 1000 patients based on uncoordinated care criteria & other
medication related criteria
 Initial CMR conducted with patient
 Targeted medication review (TMR) may also be done with Primary
Care Physician or Behavioral Health provider
 Medication Action/Treatment Plan determined then shared with
provider(s) & communicated to patient
 Ongoing care coordination & medication reviews with a focus on
communications between prescribers/providers (integrated into
case management activities)
 Quarterly assessment of changes in utilization & quality measures
 Will be looking at patient-care and medical cost related outcomes
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Summary of UF’s MTM Program
 Adaptability
 Flexible staffing
 Continues quality monitoring and performance
improvement
 Academic and research resources
 Clinical expertise and experience
31
The UF MTM Promise
 Proceed with patient permission.
 Be prepared for patient.
 Give patient our undivided
We will:
attention.
 Never be interrupted.
 Never interrupt the patient.
 Give the patient time to think.
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Questions?
Teresa E. Roane, PharmD, BCACP
Clinical Assistant Professor
[email protected]
Daryl E. Miller, PharmD
MTM and Geriatrics PGY-1 Pharmacy Resident
[email protected]