Transcript Slide 1
The Value of Medication
Therapy Management
Services
Purpose of 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
Pharmacists’ Evolving Role
From Dispensing
Services…
…to a clinical
service provider
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
American Pharmacists Association
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
American Pharmacists Association
Medication Therapy Reviews
• A Medication Therapy Review
(MTR) is provided at routine
intervals by a pharmacist
– Annual comprehensive MTR
– Additional comprehensive MTRs
as needed
• Targeted MTR at any time to
address new or ongoing
medication-related problems
American Pharmacists Association
What Do Patients Get From Care Aligned
With the MTMS Core Elements Model?
A complete list of all
of their medications:
Personal Medication Record
(PMR)
A guide for managing their
medications and related
conditions:
Medication-Related Action Plan
(MAP)
American Pharmacists Association
Medication Therapy Management Process
Today’s wants
and needs
Responsibility
to participate
in information
sharing and
decision making
Evaluate appropriateness, effectiveness,
safety, and compliance with medications
Identify drug therapy problems
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
Experienced Decision Making
Patient
Medication Experience
ASSESSMENT
Practitioner
Philosophy of Practice
Social Obligation
Responsibility to
identify, resolve,
and prevent
drug therapy
problems
Patient-centered
approach
Caring
Therapeutic Relationship
MTM Pharmacist/Prescriber
Relationship
Pharmacist’s Communication
with other Health Providers
• MTM Pharmacists will communicate regularly with
patient’s primary care provider, and other health care
team members as appropriate
– Describe assessment
– Describe and rationalize recommendations for medication
changes
– Recommendations for follow-up
Medications 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
American Pharmacists Association
How do we define value?
• Value on investment
– Economic
• Overall cost savings or cost
– Clinical
• Improvements in health outcomes
– Humanistic
• Patient satisfaction, improved quality of life, worker
productivity
Studies Illustrating
Value of MTMS
• Asheville Project: Diabetes
• Asheville Project: Asthma
• Diabetes Ten City Challenge
• Minnesota Experience Project
Asheville Project: Diabetes
• Evaluation of outcomes following community based
provision of MTMS to patients with diabetes covered by
a self-insured employer group
• Longitudinal study with pre- and post- data
• Participants were provided incentives including waiver of
all copays for diabetes medications and supplies
• 5 years of follow-up data
• 187 participants entered the program, with 26 continuing
at 5 years
Cranor CW, Bunting BA, Christensen DB. J Am Pharm Assoc. 2003;43:173–84.
Key Findings:
Asheville Diabetes
• Economic benefit
– Total health care costs for patients decreased
– Prescription costs increased, but medical costs decreased
• Clinical benefit
– Significant improvement seen in A1C and LDL
• Humanistic benefit
– Decreased sick leave; increased worker productivity
Asheville Project:
Asthma
• Evaluation of outcomes following community based
provision of MTMS to patients with asthma covered by a
self-insured employer group
• Longitudinal study with pre- and post- data
• Participants were provided incentives including waiver of
all copays for asthma medications and supplies
• 5 years of follow-up data
• 207 participants entered the program
Bunting BA, Cranor CW. JAPhA. 2006; 46:133-147.
Key Findings:
Asheville Asthma
• Economic benefit
– Decreased percentage of asthma patients requiring
emergency and hospital care
• Clinical benefit
– Improved asthma control sustained over 5 years
(as evidenced by FEV1 measurements)
Diabetes Ten City Challenge
• Employer-funded, collaborative health management
program for diabetes using community-based
pharmacists in 10 cities across the USA
– Pharmacists were located in:
• Independent pharmacies
• Chain pharmacies
• Ambulatory care clinics
• On-site workplace locations
• Participants received waived co-pays for medications.
• 573 patients participated
Fera T., Bluml BM, Ellis WM. JAPhA. 2009; 49e52-e60.
Key Findings:
10 City Challenge
• Economic benefit
– Total health care costs were less than predicted
– Prescription costs increased, but overall health care
costs decreased
• Clinical benefit
– Increased percentage of patients meeting HEDIC
– process measurement goals for patients with diabetes
Minnesota Experience Project
• Evaluation of MTMS provided at 6 ambulatory care
clinics over 1 year
• 285 patients received MTMS
• HEDIS goals for hypertension and dyslipidemia were
evaluated
• Study patients were required to have 1 of 12 study
conditions
• Return on investment was calculated at 12:1
Isetts, et al., J Am Pharm Assoc. 2008;48(2):203-211
Key Findings:
Minnesota Experience Project
• Economic benefit
– A 12:1 return on investment was seen
– Savings was seen in facilities costs
– Per person per year costs decreased from $11,965 to
$8197
• Clinical benefit
– The MTM intervention group had a higher percentage of
patients meeting HEDIS goals for hypertension and
dyslipidemia
Summary of evidence of
Value of MTMS
• Economical
– 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.
Reimbursement Structure
• Recommend utilizing the MTMS CPT billing codes
• May used them as defined as time based codes,
or use a cross-walk relative value scale
Establishment of Billing Codes
• Three (3) ‘pharmacist only’ CPT professional service
codes to bill third-party payers for MTM Services
delivered face-to-face between a pharmacist and a
patient
– 99605 is to be used for a first-encounter service (up to
15 minutes)
– 99606 is to be used for a follow-up encounter with an
established patient (up to 15 minutes)
– 99607 may be used with either 99605 or 99606 to bill
additional 15-minute increments.
• Classified as Category 1 and became eligible for use
January 1, 2008.
Beebe M, Dalton JA, Espronceda M, et. al. Current Procedural Terminology 2009.
American Medical Association: Chicago, IL.
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
• High satisfaction rates among participants