Medication Therapy Management
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How to provide medication therapy management services at a retail pharmacy.

How to provide medication therapy management services at a retail pharmacy.

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  • I would like to propose a new service for our organization today, which an extension of pharmacist consultation and is supported by the American Pharmacist Association. It is called medication therapy management.
  • Here is our company mission. Read slide.
  • Read slide. Note the alignment of MTM to this part of the company mission.
  • Now lets talk about company goal number 1
  • Our company goal is quite simple. Read. Read each health care service list and expand on it.
  • Read the slide and build momentum for MTM by showing it is the logical step for our company.
  • Here is 5 reasons we should consider MTM as a viable model for health maintenance and revenue generation.
  • Read each item. Explain each core element of the service model.
  • This slide talks about the importance IT will play in rolling out this part of business
  • Read the slide.
  • This slide shows how many minutes should be allocated to a basic appointment.Therapy review is 7 minutes, PMR is 5 minutes…etc…
  • Here are the ten action items we should consider in our plan.
  • The three most important factors to do first are HIPAA, licensing and marketing, the others being prioritized as follows.
  • Now lets take a look at staffing concerns for the clinic.
  • Read slide. Note clinic staffing needs and phase one and two suggestions
  • Now lets talk about financing our project.
  • Equity financing is a chosen vehicle we use often. Read slide.
  • We are familiar with debt financing as well. Current liabilities are due in one year
  • Read slide.
  • Our capital structure is quite secure as we more forward in achieving our goals
  • IT department has design a template for our computer system, Intercom Plus.
  • What are the ethical and legal concerns we need to consider?
  • Read the slide. Emphasize HIPAA, licensing etc..
  • The AJ model of ethical and moral decision making.
  • Pharmacists should consider these 5 issues.
  • Read the slide
  • How will the patient benefit from this issue?
  • Read slide.
  • There are many documents at the Medicare website that give guidelines on MTM requirements for Medicare Part D.
  • Read the slide. Note 1.5 million and image how many of our customers need this service.
  • Customers will save money. We will have more value to them.
  • Common question that patients ask their pharmacist can be dealt with in a more profound manner at MTM clinics. Note where 80 percent of the concerns are.
  • Adverse reactions are common among patients who take multiple medications, therefore, MTM should help alleviate these effects, and contribute to enhanced quality of life.
  • Lets talk about clinic focus.
  • Here are the disease states we should focus on, based on research.
  • Here are the six top prospects for out clinic. Note level of importance and ease of implementation
  • Here we find that diabetes and hypertension were our best options for implementation of an MTM clinic, due to the commonality of disease states in America
  • According to our chart, diabetes, hypertension and cancer pain management produce about 61% of profit potential for our clinic.
  • Making Appointments. Read the slide. Answer questions.
  • Product and price. Read the slide
  • Promotion and place. Read the slide. Answer questions.
  • Now lets talk about MTM and ethics policies.
  • Read the slide
  • Prescription medications have assisted many people in living a better life.
  • The role of the pharmacist in MTM is to provide a service that improves the health outcomes of individuals.
  • Lets talk about constraint management.
  • Discuss definition and three types of constraints
  • Constraints must be managed by the healthcare manager. He must make sure bottlenecks are continually addressed, that constraints are elevated and broken, to make sure business goals are realized.
  • Thank you. Lets take some questions.

Medication Therapy Management Presentation Transcript

  • 1. Medication Therapy Management (MTM)
    12/23/2008
    Medication Therapy Management
    1
    Improving Medication Use.
    Advancing Patient Care.
  • 2. mission
    “We will treat each other with respect and dignity and do the same for all we serve.
    We will offer employees of all backgrounds a place to build careers.
    We will provide the most convenient access to healthcare services and consumer goods in America.
    We will earn the trust of our customers and build shareholder value.”
    12/23/2008
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    Medication Therapy Management
  • 3. Mission
    “We will provide the most convenient access to healthcare services and consumer goods in America.”
    Medication therapy management (MTM) aligns well with our desire to provide convenient access to health care services and provide equity for our shareholders.
    12/23/2008
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    Medication Therapy Management
  • 4. 12/23/2008
    Corporate Goal #1
    4
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  • 5. Corporate Goal 1:Provide the most convenient access to health care services
    Take Care Clinics
    Immunization Clinics
    Diabetes Programs
    Breast Cancer Awareness
    Health and Wellness Programs
    What should we consider next?
    12/23/2008
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  • 6. Health Care Initiatives
    Take Care Clinics
    Immunization Clinics
    Diabetes Programs
    Breast Cancer Awareness
    Health and Wellness Programs
    Medication Therapy Management (MTM)
    12/23/2008
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  • 7. Why MTM!
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  • 8. MTM Core Elements Service Model
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    Source: Medication therapy management in pharmacy practice: Core elements of an MTM service model (version 2.0). Journal of the American Pharmacists Association , 341-353.
    8
    Medication Therapy Management
  • 9. Information Technology
    We will use leading edge software applications to improve clinic throughput.
    Laptop computer with handwriting capabilities that transform into typed text
    Laptop will have direct connection to Intercom Plus Pharmacy System database
    To make access to patient records seamless
    To capture information and decrease clinic response time
    To determine customer eligibility for services
    To speed revenue cycle billing
    12/23/2008
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  • 10. Time allocation for MTM
    The following slide reveals a proposed dispersion of time for the pharmacist to perform each task in an MTM clinical setting.
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  • 11. 12/23/2008
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  • 12. Action Items
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  • 13. Ten Action ItemsFocus Table
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  • 14. Ten Action ItemsFocus Matrix
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  • 15. Human Resources
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  • 16. Human Resources
    Each clinic will require 1 new pharmacist.
    Phase 1
    Pilot 5 Stores in Chicago and Tampa markets
    Recruit and train pharmacist market trainers
    Phase 2
    Implementation in Chicago and Tampa markets.
    Recruit and train market trainers
    15 pharmacist/ 15 stores
    12/23/2008
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  • 17. Financing
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  • 18. Financing MTM
    Equity Financing
    Share Walgreens- Management and pharmacist are given stock options in exchange for purchasing shares.
    Employee stock purchase plans (ESOP)
    Cash purchase
    10% discount
    Loan purchase
    4 year terms
    12/23/2008
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  • 19. FinanceShort-term debt
    Debt financing
    Use short term debt to finance pilot program in Chicago and Tampa
    Commercial paper
    Bank loans
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  • 20. FinanceLong-term debt
    Use long term debt to roll out nationwide
    Corporate bonds
    20-30 year fixed rate bonds
    Debentures
    Advantage: No lien against specific property
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  • 21. Summary
    Capital structure is a major contributor to business strategy execution. Most companies use a combination of debt and equity financing to fund implementation of new projects. The most important part of a business financial plan is financial forecasting. Financial forecasting components are:
    An analysis of the business’s current situation
    A revenue forecast
    The capital budget
    The cash budget
    A set of pro forma financial statements
    External financial plan
    An analysis of the firm’s projected financial condition
    Source: Gapenski, L.C. , Understanding Healthcare Financial Management, 2007 p 501-533
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  • 22. Operations
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  • 23. Operations
    The Intercom Plus Pharmacy Computer System has the ability to incorporate MTM.
    Access patient profiles by entering the patients phone number or date of birth
    Select the MTM button on the applications menu to open data entry screens
    The pharmacist enters data directly into patients records
    The quick analysis button reviews patients drug history after all medications, including OTC’s and herbals, are entered, giving pharmacist talking points.
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  • 24. Ethical and Legal Issues
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  • 25. Legal RequirementsHIPAA
    MTM services should be delivered in a private or semi-private area, as required by the Health Insurance Portability and Accountability Act.
    What we can do to comply
    This can be accomplished by using private rooms in our Take Care Clinics.
    Pharmacist and technician licensed posted
    Provide patients with a notice of privacy practices
    Disclaimers given
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  • 26. Ethical Issues
    MTM closely aligns with the Analysis and Justification (AJ) model of ethical decision making. Making decision in what to tell the patient at clinics will be a matter ethical training programs by the company. This includes
    Information gathering
    Creative problem solving
    Listing of pros and cons
    Analysis
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  • 27. Ethical Issues
    Be truthful with the patient about whether the therapy is working.
    Do not alarm patient with unnecessary information.
    Do not over charge third party payors to cover losses in other plans.
    Do not operate a clinic without a license or mal-practice insurance.
    Maintain the protection of confidential patient conversations
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  • 28. Summary
    Ethical and legal issues pervade the pharmacy profession and have an indelible impact on MTM. Staying abreast of changes in the licensing and certification issues, along with having a good handle of what therapy regimen is in the patients best interest, will provide value for the organization and customer.
    12/23/2008
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  • 29. Patient Benefits
    Personal attention from drug therapy experts
    Computer generated medication action plan that is easy to follow
    Improved patient compliance to medications
    Improved patient health outcomes
    Improved patient quality of life years
    Elimination of unnecessary drugs or harmful drug interactions
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  • 30. Contemporary Issues
    Poly-pharmacy
    Adverse drug reactions
    Prescription savings
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  • 31. Poly-pharmacy
    Many patients who have Medicare Part D insurance are on 4 or more medications. Patients with diabetes, hypertension, glaucoma and arthritis may be on as many as 10 or more medications daily.
    MTM is a opportunity for pharmacists to help patients manage therapy, by finding the best ways to treat multiple-disease states and minimize adverse drug reactions.
    MTM will also provide additional revenue for pharmacists through fee for service or third party payor reimbursement.
    Source: www.Medicare.gov
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  • 32. Adverse Drug Reactions
    Medication-related problems are a significant public health issue with the health care system. Incidence estimates suggest that more than 1.5 million preventable medication-related adverse events occur each year.
    Source: Medication therapy management in pharmacy practice: Core elements of an MTM service model (version 2.0). Journal of the American Pharmacists Association , 341-353.
    12/23/2008
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  • 33. Prescription Savings
    Pharmacist intervention can provide access to
    better care by making medication affordable.
    This is inclusive of generic substitution or
    therapeutic substitutions which are able to
    improve patient health and well being.
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  • 34. 12/23/2008
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  • 35. Contemporary Issues
    All medications have or can produces adverse reactions due to allergy, interaction with other medications or food, or due to pharmacologic effect wearing off. Adverse reactions do not decrease according to high cost of medications, therefore, prescriptions savings are a great option for all patients. Adverse reactions are common among patients who take multiple medications, therefore, MTM should help alleviate these effects, and contribute to enhanced quality of life.
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  • 36. Clinic Focus
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  • 37. Targeted Disease States
    Phase 1
    Diabetes
    Heart disease
    Cancer pain management
    Phase 2
    Asthma
    Hyperlipidemia
    Weight loss
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  • 38. Focus Chart6 Top Prospects for MTM clinics
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  • 39. Focusing Matrix
    Diabetes
    Hypertension
    Cancer pain management
    Asthma
    Hyperlipidemia
    Weight loss
    The MTM programs we should implement first are for diabetes and hypertension. There has been a three fold increase in the incidence of diabetes in the U. S. since 1980. Obesity is a major contributor to both diabetes and hypertension. Here is an opportunity for the company to expand its influence in providing access to care.
    Source: www.cdc.gov
    12/23/2008
    Importance
    Ease of Implementation
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  • 40. Profit Potential
    According to our chart, diabetes, hypertension and cancer pain management produce about 61% of profit potential for our clinic. A weight loss component to the clinic could improve all health conditions, decreasing blood pressure, lead to better blood glucose control and decrease cancer rates due to decreased fat consumption, and increased consumption of fruits and vegetable.
    12/23/2008
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  • 41. 12/23/2008
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    Profit Potential
  • 42. Making Appointments
    Intercom Plus can identify patients who fit Medicare Part D or private insurance criteria for MTM intervention
    Pharmacists can indentify patients who would benefit from the service and schedule appointments between 8:30am to 4pm, Monday-Friday.
    Appointment should be 20 minutes in duration to be profitable
    12/23/2008
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  • 43. Marketing Plan
    Product: MTM is designed to be a once a year review of patient’s medication history. The company will introduce MTM as a value added service, to promote patient health and wellbeing, and improve company revenue.
    Pricing: Introductory fee for service will be $60 for twenty minutes of service. The price is expected to lower as more stores participate in the roll-out.
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  • 44. Marketing Plan
    Promotion: Sales promotions will be done weekly in the advertising bulletin, on the company website, direct mail and electronic media. Corporate sales persons will negotiate with third party payors to establish revenue generation. Primary target: Senior citizens with Medicare Part D.
    Place: Chicago and Tampa markets will pilot the program. After this, the plan is to expand to all districts in Eastern and Western Operations
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  • 45. MTM and Ethics
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  • 46. MTM and Ethics
    The pharmacist in a clinic environment can act ethically by:
    Maintaining the patients privacy
    Monitoring the effectiveness of patients therapy
    Motivating patients to take charge of their health issues
    Mitigating the affect of drug regimens that are outdated or mal-conceived
    Maintain and improve the perception of pharmacy practice as a viable and valuable service to experience
    Source: http://www.hhs.gov/ocr/hipaa/consumer_rights.pdf
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  • 47. MTM and Ethics
    Prescription medications have assisted many people in living a better life. They have given hope to patients with diabetes, asthma, cancer and hypertension. However, most people will benefit from at least on complete medication review from a specially trained pharmacist, to solve medication problems, dosing parameters and manage drug allergies and other adverse reactions. It is the duty of the pharmacist to keep patients informed about how to best take care of themselves with proper medication understand and usage.
    12/23/2008
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  • 48. Ethics
    The role of the pharmacist in MTM is to provide a service that improves the health outcomes of individuals. Information given to the patient must to easy to understand and relevant to individual need. This includes bringing a patients blood sugar under control, blood pressure under control, or controlling pain due to cancer.
    MTM implementation in the next few years could benefit in cost saving to the health care system by way of decreased hospitalizations due to adverse drug reactions, improved patient compliance and decreased patient out of pocket costs.
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  • 49. Constraint Management
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  • 50. Constraint management
    Constraints are problems in the MTM system that prevent the goal of offering more services from being reached.
    Resource constraints- Not having enough pharmacists to open a clinic in a region
    Market constraint-Competitors can quickly copy the MTM idea. First to market can garner market share
    Policy constraint- Medicare and other insurers can enact a policy that decreases reimbursement to pharmacies for MTM. This can effect overall profitability
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  • 51. Constraint management
    Constraints must be managed by the healthcare manager. He must make sure bottlenecks are continually addressed, that constraints are elevated and broken, to make sure business goals are realized.
    Source: Ronen, B., & Pliskin, J. S. (2006). Focused Operations Management for Health Services Organizations. San Francisco: Jossey-Bass.
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  • 52. Thank You!
    Medication Therapy Management
    Improving Medication Use
    Advancing Patient Care
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