Medication Therapy Management

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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

    1. 1. Medication Therapy Management (MTM)<br />12/23/2008<br />Medication Therapy Management<br />1<br />Improving Medication Use. <br />Advancing Patient Care.<br />
    2. 2. mission<br />“We will treat each other with respect and dignity and do the same for all we serve.<br />We will offer employees of all backgrounds a place to build careers.<br />We will provide the most convenient access to healthcare services and consumer goods in America.<br />We will earn the trust of our customers and build shareholder value.”<br />12/23/2008<br />2<br />Medication Therapy Management<br />
    3. 3. Mission<br />“We will provide the most convenient access to healthcare services and consumer goods in America.”<br /> Medication therapy management (MTM) aligns well with our desire to provide convenient access to health care services and provide equity for our shareholders.<br />12/23/2008<br />3<br />Medication Therapy Management<br />
    4. 4. 12/23/2008<br />Corporate Goal #1<br />4<br />Medication Therapy Management<br />
    5. 5. Corporate Goal 1:Provide the most convenient access to health care services<br />Take Care Clinics<br />Immunization Clinics<br />Diabetes Programs<br />Breast Cancer Awareness<br />Health and Wellness Programs<br />What should we consider next?<br />12/23/2008<br />5<br />Medication Therapy Management<br />
    6. 6. Health Care Initiatives<br />Take Care Clinics<br />Immunization Clinics<br />Diabetes Programs<br />Breast Cancer Awareness<br />Health and Wellness Programs<br />Medication Therapy Management (MTM)<br />12/23/2008<br />6<br />Medication Therapy Management<br />
    7. 7. Why MTM!<br />12/23/2008<br />Medication Therapy Management<br />7<br />
    8. 8. MTM Core Elements Service Model<br />12/23/2008<br />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.<br />8<br />Medication Therapy Management<br />
    9. 9. Information Technology<br /> We will use leading edge software applications to improve clinic throughput.<br />Laptop computer with handwriting capabilities that transform into typed text<br />Laptop will have direct connection to Intercom Plus Pharmacy System database<br />To make access to patient records seamless<br />To capture information and decrease clinic response time <br />To determine customer eligibility for services<br />To speed revenue cycle billing <br />12/23/2008<br />9<br />Medication Therapy Management<br />
    10. 10. Time allocation for MTM<br /> The following slide reveals a proposed dispersion of time for the pharmacist to perform each task in an MTM clinical setting.<br />12/23/2008<br />Medication Therapy Management<br />10<br />
    11. 11. 12/23/2008<br />11<br />Medication Therapy Management<br />
    12. 12. Action Items<br />12/23/2008<br />Medication Therapy Management<br />12<br />
    13. 13. Ten Action ItemsFocus Table<br />12/23/2008<br />13<br />Medication Therapy Management<br />
    14. 14. Ten Action ItemsFocus Matrix<br />12/23/2008<br />14<br />Medication Therapy Management<br />
    15. 15. Human Resources<br />12/23/2008<br />Medication Therapy Management<br />15<br />
    16. 16. Human Resources<br />Each clinic will require 1 new pharmacist. <br />Phase 1<br />Pilot 5 Stores in Chicago and Tampa markets<br />Recruit and train pharmacist market trainers<br />Phase 2<br />Implementation in Chicago and Tampa markets. <br />Recruit and train market trainers<br />15 pharmacist/ 15 stores<br />12/23/2008<br />16<br />Medication Therapy Management<br />
    17. 17. Financing<br />12/23/2008<br />Medication Therapy Management<br />17<br />
    18. 18. Financing MTM<br />Equity Financing<br />Share Walgreens- Management and pharmacist are given stock options in exchange for purchasing shares.<br />Employee stock purchase plans (ESOP)<br />Cash purchase<br />10% discount <br />Loan purchase<br />4 year terms<br />12/23/2008<br />18<br />Medication Therapy Management<br />
    19. 19. FinanceShort-term debt<br />Debt financing<br />Use short term debt to finance pilot program in Chicago and Tampa<br />Commercial paper<br />Bank loans<br />12/23/2008<br />19<br />Medication Therapy Management<br />
    20. 20. FinanceLong-term debt <br />Use long term debt to roll out nationwide<br />Corporate bonds<br />20-30 year fixed rate bonds<br />Debentures <br />Advantage: No lien against specific property<br />12/23/2008<br />20<br />Medication Therapy Management<br />
    21. 21. Summary <br /> 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:<br />An analysis of the business’s current situation<br />A revenue forecast<br />The capital budget<br />The cash budget<br />A set of pro forma financial statements<br />External financial plan<br />An analysis of the firm’s projected financial condition<br />Source: Gapenski, L.C. , Understanding Healthcare Financial Management, 2007 p 501-533<br />12/23/2008<br />Medication Therapy Management<br />21<br />
    22. 22. Operations <br />12/23/2008<br />Medication Therapy Management<br />22<br />
    23. 23. Operations<br /> The Intercom Plus Pharmacy Computer System has the ability to incorporate MTM.<br />Access patient profiles by entering the patients phone number or date of birth<br />Select the MTM button on the applications menu to open data entry screens<br />The pharmacist enters data directly into patients records<br />The quick analysis button reviews patients drug history after all medications, including OTC’s and herbals, are entered, giving pharmacist talking points. <br />12/23/2008<br />23<br />Medication Therapy Management<br />
    24. 24. Ethical and Legal Issues<br />12/23/2008<br />24<br />Medication Therapy Management<br />
    25. 25. Legal RequirementsHIPAA <br />MTM services should be delivered in a private or semi-private area, as required by the Health Insurance Portability and Accountability Act.<br />What we can do to comply<br />This can be accomplished by using private rooms in our Take Care Clinics.<br />Pharmacist and technician licensed posted<br />Provide patients with a notice of privacy practices<br />Disclaimers given<br />12/23/2008<br />25<br />Medication Therapy Management<br />
    26. 26. Ethical Issues<br /> 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<br />Information gathering<br />Creative problem solving<br />Listing of pros and cons<br />Analysis<br />12/23/2008<br />26<br />Medication Therapy Management<br />
    27. 27. Ethical Issues<br />Be truthful with the patient about whether the therapy is working.<br />Do not alarm patient with unnecessary information.<br />Do not over charge third party payors to cover losses in other plans.<br />Do not operate a clinic without a license or mal-practice insurance.<br />Maintain the protection of confidential patient conversations<br />12/23/2008<br />27<br />Medication Therapy Management<br />
    28. 28. Summary <br /> 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.<br />12/23/2008<br />28<br />Medication Therapy Management<br />
    29. 29. Patient Benefits<br />Personal attention from drug therapy experts<br />Computer generated medication action plan that is easy to follow<br />Improved patient compliance to medications<br />Improved patient health outcomes<br />Improved patient quality of life years<br />Elimination of unnecessary drugs or harmful drug interactions<br />12/23/2008<br />29<br />Medication Therapy Management<br />
    30. 30. Contemporary Issues<br />Poly-pharmacy <br />Adverse drug reactions<br />Prescription savings<br />12/23/2008<br />30<br />Medication Therapy Management<br />
    31. 31. Poly-pharmacy<br />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.<br />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.<br />MTM will also provide additional revenue for pharmacists through fee for service or third party payor reimbursement.<br />Source: www.Medicare.gov<br />12/23/2008<br />31<br />Medication Therapy Management<br />
    32. 32. Adverse Drug Reactions<br /> 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.<br />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.<br />12/23/2008<br />32<br />Medication Therapy Management<br />
    33. 33. Prescription Savings<br /> Pharmacist intervention can provide access to <br /> better care by making medication affordable. <br /> This is inclusive of generic substitution or <br /> therapeutic substitutions which are able to <br /> improve patient health and well being.<br />12/23/2008<br />33<br />Medication Therapy Management<br />
    34. 34. 12/23/2008<br />Medication Therapy Management<br />34<br />
    35. 35. Contemporary Issues<br /> 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.<br />12/23/2008<br />Medication Therapy Management<br />35<br />
    36. 36. Clinic Focus<br />12/23/2008<br />Medication Therapy Management<br />36<br />
    37. 37. Targeted Disease States<br />Phase 1<br />Diabetes<br />Heart disease<br />Cancer pain management<br />Phase 2<br />Asthma <br />Hyperlipidemia<br />Weight loss <br />12/23/2008<br />37<br />Medication Therapy Management<br />
    38. 38. Focus Chart6 Top Prospects for MTM clinics<br />12/23/2008<br />38<br />Medication Therapy Management<br />
    39. 39. Focusing Matrix<br />Diabetes<br />Hypertension<br />Cancer pain management<br />Asthma<br />Hyperlipidemia<br />Weight loss<br /> 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.<br />Source: www.cdc.gov<br />12/23/2008<br />Importance <br />Ease of Implementation<br />39<br />Medication Therapy Management<br />
    40. 40. Profit Potential <br /> 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.<br />12/23/2008<br />Medication Therapy Management<br />40<br />
    41. 41. 12/23/2008<br />Medication Therapy Management<br />41<br />Profit Potential<br />
    42. 42. Making Appointments<br />Intercom Plus can identify patients who fit Medicare Part D or private insurance criteria for MTM intervention<br />Pharmacists can indentify patients who would benefit from the service and schedule appointments between 8:30am to 4pm, Monday-Friday.<br />Appointment should be 20 minutes in duration to be profitable<br />12/23/2008<br />42<br />Medication Therapy Management<br />
    43. 43. Marketing Plan<br />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.<br />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.<br />12/23/2008<br />43<br />Medication Therapy Management<br />
    44. 44. Marketing Plan<br />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.<br />Place: Chicago and Tampa markets will pilot the program. After this, the plan is to expand to all districts in Eastern and Western Operations<br />12/23/2008<br />44<br />Medication Therapy Management<br />
    45. 45. MTM and Ethics<br />12/23/2008<br />Medication Therapy Management<br />45<br />
    46. 46. MTM and Ethics<br />The pharmacist in a clinic environment can act ethically by:<br />Maintaining the patients privacy<br />Monitoring the effectiveness of patients therapy<br />Motivating patients to take charge of their health issues<br />Mitigating the affect of drug regimens that are outdated or mal-conceived<br />Maintain and improve the perception of pharmacy practice as a viable and valuable service to experience<br />Source: http://www.hhs.gov/ocr/hipaa/consumer_rights.pdf<br />12/23/2008<br />46<br />Medication Therapy Management<br />
    47. 47. MTM and Ethics<br /> 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.<br />12/23/2008<br />47<br />Medication Therapy Management<br />
    48. 48. Ethics<br /> 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. <br /> 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.<br />12/23/2008<br />Medication Therapy Management<br />48<br />
    49. 49. Constraint Management<br />12/23/2008<br />Medication Therapy Management<br />49<br />
    50. 50. Constraint management<br /> Constraints are problems in the MTM system that prevent the goal of offering more services from being reached.<br />Resource constraints- Not having enough pharmacists to open a clinic in a region<br />Market constraint-Competitors can quickly copy the MTM idea. First to market can garner market share<br />Policy constraint- Medicare and other insurers can enact a policy that decreases reimbursement to pharmacies for MTM. This can effect overall profitability<br />12/23/2008<br />Medication Therapy Management<br />50<br />
    51. 51. Constraint management<br /> 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.<br />Source: Ronen, B., & Pliskin, J. S. (2006). Focused Operations Management for Health Services Organizations. San Francisco: Jossey-Bass.<br />12/23/2008<br />Medication Therapy Management<br />51<br />
    52. 52. Thank You!<br />Medication Therapy Management<br />Improving Medication Use<br />Advancing Patient Care<br />12/23/2008<br />52<br />Medication Therapy Management<br />

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