Pharmacists Improving Care  and Reducing Costs  image001 logo
Medication Therapy  Management, LLC <ul><li>Medication Therapy Services, LLC 235 Greenwood Street, Cranston, RI 02910 Phon...
Scope of  Medication-Related Problems <ul><li>Significant impact on public health resulting from medication-related injury...
Medication-Related Problems     $$$$ Increased Costs to the Health Care System $$$$ Increased Costs to Employers $$$$ Incr...
What Is Medication Therapy Management (MTM)? <ul><li>Services provided by a pharmacist that improve treatment outcomes for...
<ul><li>Who Needs Medication Therapy Management? </li></ul>MPj04223650000[1] understanding-diabetes-ga-2 Business-People a...
Where Are You Spending Your  Health Care Dollars? Kaiser Family Foundation, 2007. http://www.kff.org/insurance/index.cfm
The Spectrum of  Pharmacist-Provided MTM <ul><li>Comprehensive or Targeted Medication Therapy Reviews  </li></ul><ul><li>A...
MTM Core Elements  Service Model   Core Elements <ul><li> Developed by the American Pharmacists Association and the Nation...
Components of the MTM Core Elements Service Model   <ul><li>Medication Therapy Review (MTR) – a review of all medications ...
Medication Therapy Reviews <ul><li>A Medication Therapy Review (MTR) is a “Medication Check-Up” provided at routine interv...
What Do Patients Get From Care Aligned With the MTM Core Elements Model? <ul><li>A complete list of all of their medicatio...
Examples of MTM Interventions   <ul><li>Medication Adherence  </li></ul><ul><ul><li>Medication-related problem  </li></ul>...
Examples of MTM Interventions   <ul><li>Missing Therapy </li></ul><ul><ul><li>Medication-related problem </li></ul></ul><u...
A Case Example From Our Practice   <ul><li>55 yo male with Type 2 Diabetes </li></ul><ul><li>Duplication of Therapy:  Pres...
A Case Example From Our Practice
Goals of MTM Services  <ul><li>Patients </li></ul><ul><ul><li>More medication-related problems identified and resolved </l...
MTM Services In Action   <ul><li>Minnesota Medication Therapy Management Care Program  </li></ul><ul><li>The Asheville Pro...
Clinical Outcomes of MTM Minnesota MTM Care Program <ul><li>3.1 drug therapy problems identified and resolved  per recipie...
Clinical Outcomes of MTM The Asheville Project - Asthma Improved  Asthma control sustained over  5 years Bunting BA, Crano...
Clinical Outcomes of MTM The Asheville Project - Diabetes A1C < 7% Total Cholesterol  < 200 mg/dl LDL < 100 mg/dl Cranor C...
 Clinical Outcomes of MTM [customize this slide to meet the needs of your target audience - may include clinical outcomes ...
Economic Outcomes of MTM Minnesota Medicaid MTM Care Program Decrease  in : <ul><li>Prescriber & non-prescriber provider c...
Total costs  $9,035   $8,913  $8,802   $7,490 (N = 63) Year 3 Savings Per Patient from  Projected  Costs $6,250 from  Base...
Economic Outcomes of MTM From Our Practice [ customize this slide to meet the needs of your target audience –include econo...
<ul><li>American Pharmacists Association survey of pharmacist providers and payers  </li></ul><ul><ul><li>MTM implementati...
<ul><li>Providers  </li></ul><ul><ul><li>E - mail survey conducted November/December 2007  </li></ul></ul><ul><ul><li>Dist...
<ul><li>MTM services are being provided in diverse geographic areas and diverse care settings </li></ul><ul><li>MTM servic...
<ul><li>10 respondents reported ROI for MTM programs </li></ul><ul><ul><li>Ranged from 2:1 to 12:1  </li></ul></ul><ul><ul...
APhA Survey Findings of  Health Care Measures/Needs Addressed by MTM Services Schommer JC, Planas LG, Johnson KA, et al. P...
APhA Survey Findings of Impact of MTM on Future Outcomes Schommer JC, Planas LG, Johnson KA, et al. Pharmacist-provided me...
Considerations for Providing MTM Services <ul><li>Any patient who wants/needs MTM services should have access  </li></ul><...
Our MTM Service Offering <ul><li>Medication Therapy Reviews (using the established MTM Core Elements Service Model) </li><...
[Insert Name of the MTM Practice  (Pharmacy or Pharmacist)] <ul><li>[insert content] </li></ul>
Billing, Compensation,  and Reporting   <ul><li>Billing  </li></ul><ul><ul><li>Covered by some insurance plan, else self-p...
Billing, Compensation,  and Reporting   <ul><li>[insert content] </li></ul>
Together we can…   <ul><li>Reduce the risk caused by medication-related problems </li></ul><ul><li>Improve care and outcom...
Contact Information   <ul><li>Medication Therapy Services, LLC </li></ul><ul><li>235 Greenwood Street, Cranston, RI 02910 ...
Appendix to Slide Set  (use/modify/incorporate into slide set if desired) <ul><li>Patient Case Example  </li></ul><ul><li>...
Clinical Outcomes of MTM Asthma Patients Bunting BA, Cranor CW. The Asheville Project: long-term clinical, humanistic, and...
Economic Outcomes of MTM Decrease in yearly Rx cost to health plan (N = 7 patients) Rx cost to patient/year  (N = 7 patien...
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MTM Presentation

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  1. 1. Pharmacists Improving Care and Reducing Costs image001 logo
  2. 2. Medication Therapy Management, LLC <ul><li>Medication Therapy Services, LLC 235 Greenwood Street, Cranston, RI 02910 Phone 401-484-1479 * Fax 401-270-0378 </li></ul><ul><li>Team of specially trained pharmacists </li></ul><ul><li>Out goal is our patient’s health and quality of life, NOT prescription volume allowing our pharmacists to treat our clients as patients, instead of a customers. </li></ul>
  3. 3. Scope of Medication-Related Problems <ul><li>Significant impact on public health resulting from medication-related injury and death </li></ul><ul><li>More than 1.5 million preventable medication-related adverse events occur each year </li></ul><ul><li>Inappropriate use of medications costs an estimated $177 billion annually </li></ul>Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41:192 – 9. Institute of Medicine. Report Brief: Preventing Medication Errors. Washington, DC: Institute of Medicine; July 2006. http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf.
  4. 4. Medication-Related Problems $$$$ Increased Costs to the Health Care System $$$$ Increased Costs to Employers $$$$ Increased Insurance Premiums or Direct Costs dd_senior_drug_caution images
  5. 5. What Is Medication Therapy Management (MTM)? <ul><li>Services provided by a pharmacist that improve treatment outcomes for individual patients </li></ul><ul><li>A professional service to promote the safe and effective use of medications </li></ul><ul><li>A way to provide better care for patients </li></ul><ul><ul><li>Promotes collaboration among the patient, the pharmacist, and the patient’s other health care providers </li></ul></ul><ul><li>Bluml BM. Definition of medication therapy management: development of professionwide consensus. J Am Pharm Assoc . 2005;45:566 – 72. </li></ul>
  6. 6. <ul><li>Who Needs Medication Therapy Management? </li></ul>MPj04223650000[1] understanding-diabetes-ga-2 Business-People asthma_child140
  7. 7. Where Are You Spending Your Health Care Dollars? Kaiser Family Foundation, 2007. http://www.kff.org/insurance/index.cfm
  8. 8. The Spectrum of Pharmacist-Provided MTM <ul><li>Comprehensive or Targeted Medication Therapy Reviews </li></ul><ul><li>Adherence Services </li></ul><ul><ul><li>Based on the number and/or type of medications </li></ul></ul><ul><li>Targeted Medication Intervention Programs </li></ul><ul><ul><li>High-alert and/or high-cost medications </li></ul></ul><ul><ul><li>Targeted patient population (i.e. geriatrics, pediatrics) </li></ul></ul><ul><li>Disease State Management </li></ul><ul><ul><li>Interdisciplinary approach to achieve therapeutic goals </li></ul></ul><ul><ul><li>Example disease states: Diabetes, Cholesterol, Asthma </li></ul></ul><ul><li>Health and Wellness Services </li></ul><ul><ul><li>Wellness screenings </li></ul></ul><ul><ul><li>Smoking cessation </li></ul></ul>
  9. 9. MTM Core Elements Service Model Core Elements <ul><li> Developed by the American Pharmacists Association and the National Association of Chain Drug Stores Foundation </li></ul><ul><li> Supported by 10 national pharmacy organizations </li></ul>
  10. 10. Components of the MTM Core Elements Service Model <ul><li>Medication Therapy Review (MTR) – a review of all medications including prescription, nonprescription, herbal products, and other dietary supplements </li></ul><ul><li>Personal Medication Record (PMR) </li></ul><ul><li>Medication-Related Action Plan (MAP) for the patient </li></ul><ul><li>Intervention and/or Referral </li></ul><ul><li>Documentation and Follow-Up </li></ul>
  11. 11. Medication Therapy Reviews <ul><li>A Medication Therapy Review (MTR) is a “Medication Check-Up” provided at routine intervals by a pharmacist </li></ul><ul><ul><ul><li>Annual comprehensive MTR </li></ul></ul></ul><ul><ul><ul><li>Additional comprehensive MTRs as needed </li></ul></ul></ul><ul><li>Targeted MTR at any time to address new or ongoing medication-related problems </li></ul>photo_06_News
  12. 12. What Do Patients Get From Care Aligned With the MTM Core Elements Model? <ul><li>A complete list of all of their medications: Personal Medication Record (PMR) </li></ul><ul><li>A guide for managing their medications and related conditions: Medication-Related Action Plan (MAP) </li></ul>
  13. 13. Examples of MTM Interventions <ul><li>Medication Adherence </li></ul><ul><ul><li>Medication-related problem </li></ul></ul><ul><ul><ul><li>Overuse of albuterol inhaler and suboptimal use of inhaled steroids in the treatment of asthma </li></ul></ul></ul><ul><ul><li>Impact of MTM </li></ul></ul><ul><ul><ul><li>Reduce ER visits, hospitalizations </li></ul></ul></ul><ul><li>Medication Interactions </li></ul><ul><ul><li>Medication-related problem </li></ul></ul><ul><ul><ul><li>Use of medications that can potentially increase the effect of warfarin (blood thinner) </li></ul></ul></ul><ul><ul><li>Impact of MTM </li></ul></ul><ul><ul><ul><li>Reduce risk of bleeding events, ER visits, and hospitalizations </li></ul></ul></ul>
  14. 14. Examples of MTM Interventions <ul><li>Missing Therapy </li></ul><ul><ul><li>Medication-related problem </li></ul></ul><ul><ul><ul><li>Lack of therapy recommended by treatment guidelines </li></ul></ul></ul><ul><ul><li>Impact of MTM </li></ul></ul><ul><ul><ul><li>Better care and outcomes in alignment with evidence-based guidelines </li></ul></ul></ul><ul><li>Duplicate Medication Therapy </li></ul><ul><ul><li>Medication-related problem </li></ul></ul><ul><ul><ul><li>Two or more drugs treating the same condition </li></ul></ul></ul><ul><ul><li>Impact of MTM </li></ul></ul><ul><ul><ul><li>Coordination of care with multiple health care providers </li></ul></ul></ul><ul><ul><ul><li>Reduced risk of over-dosing due to additive effects </li></ul></ul></ul>
  15. 15. A Case Example From Our Practice <ul><li>55 yo male with Type 2 Diabetes </li></ul><ul><li>Duplication of Therapy: Prescribed two ACE inhibitors </li></ul><ul><ul><li>Primary Care Physician (PCP): Lisinopril </li></ul></ul><ul><ul><li>Endocrinologist: Ramipril </li></ul></ul><ul><li>Contacted both prescribers to make them aware of this medication related problem </li></ul><ul><li>Patient was continued on Ramipril </li></ul>
  16. 16. A Case Example From Our Practice
  17. 17. Goals of MTM Services <ul><li>Patients </li></ul><ul><ul><li>More medication-related problems identified and resolved </li></ul></ul><ul><ul><li>Empowered to take an active role in their medication management </li></ul></ul><ul><li>Health Care Professionals </li></ul><ul><ul><li>Improved transitions and continuity of care </li></ul></ul><ul><ul><li>Improved medication use outcomes </li></ul></ul><ul><li>Payers </li></ul><ul><ul><li>Reduction in adverse drug events </li></ul></ul><ul><ul><li>Potential to lower health care costs </li></ul></ul>
  18. 18. MTM Services In Action <ul><li>Minnesota Medication Therapy Management Care Program </li></ul><ul><li>The Asheville Project </li></ul>
  19. 19. Clinical Outcomes of MTM Minnesota MTM Care Program <ul><li>3.1 drug therapy problems identified and resolved per recipient </li></ul><ul><li>Most common drug therapy problems: </li></ul><ul><ul><li>Dosage too low </li></ul></ul><ul><ul><li>Non-compliance </li></ul></ul><ul><ul><li>Need for additional drug therapy </li></ul></ul><ul><li>Diabetes Subset (114 recipients): </li></ul><ul><ul><li>36% of patients with diabetes met all five of the state’s quality standards </li></ul></ul><ul><ul><li>Average hemoglobin A 1 C value was 7.38% (range 4.9%-14.7%, std dev. =1.82%) </li></ul></ul><ul><ul><li>77% (88/114) of recipients with diabetes achieved hemoglobin A 1 C benchmark goal (less than or equal to 8%) </li></ul></ul>Isetts BJ. Evaluating Effectiveness of the Minnesota Medication Therapy Management Care Program. Final Report. [Submitted December 14, 2007]. Available at: http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/dhs16_140283.pdf
  20. 20. Clinical Outcomes of MTM The Asheville Project - Asthma Improved Asthma control sustained over 5 years Bunting BA, Cranor CW. The Asheville Project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma. J Am Pharm Assoc. 2006;46:133 – 47.
  21. 21. Clinical Outcomes of MTM The Asheville Project - Diabetes A1C < 7% Total Cholesterol < 200 mg/dl LDL < 100 mg/dl Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173 – 84.
  22. 22. Clinical Outcomes of MTM [customize this slide to meet the needs of your target audience - may include clinical outcomes from your practice or other specific clinical outcomes of interest to your audience]
  23. 23. Economic Outcomes of MTM Minnesota Medicaid MTM Care Program Decrease in : <ul><li>Prescriber & non-prescriber provider costs </li></ul><ul><li>Ambulatory care costs </li></ul><ul><li>Lab & Diagnostic costs </li></ul><ul><li>Other costs </li></ul>Isetts BJ. Evaluating Effectiveness of the Minnesota Medication Therapy Management Care Program. Final Report. [Submitted December 14, 2007]. Available at: http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/dhs16_140283.pdf
  24. 24. Total costs $9,035 $8,913 $8,802 $7,490 (N = 63) Year 3 Savings Per Patient from Projected Costs $6,250 from Baseline Costs $1,545 Yr 1 Projected $10,390 Year 3 Projected $13,740 Baseline $9,035 Year 2 Projected $11,948 APhA Foundation Patient Self-Management Program for Diabetes – Economic Impact Baseline, Years 1, 2, and 3 Compared With Projected Costs* Data provided by the APhA Foundation. *Projected increases based on multiple sources, not according to the ADA. Total medical expenditures incurred by people with diabetes were $13,243 per capita in 2002, compared with $2,560 for people without diabetes.
  25. 25. Economic Outcomes of MTM From Our Practice [ customize this slide to meet the needs of your target audience –include economic outcomes from analysis conducted in your own practice that may be of interest to your target audience]
  26. 26. <ul><li>American Pharmacists Association survey of pharmacist providers and payers </li></ul><ul><ul><li>MTM implementation strategies </li></ul></ul><ul><ul><li>Value of MTM services </li></ul></ul><ul><li>www.pharmacist.com/MTM </li></ul>APhA MTM Digest Examining the Value of MTM Services
  27. 27. <ul><li>Providers </li></ul><ul><ul><li>E - mail survey conducted November/December 2007 </li></ul></ul><ul><ul><li>Distributed to 6,873 providers who were likely to be involved with providing MTM </li></ul></ul><ul><ul><li>687 respondents </li></ul></ul><ul><li>Payers </li></ul><ul><ul><li>E-mail survey conducted November/December 2007 </li></ul></ul><ul><ul><li>Distributed to 1,898 individuals who were likely to be involved with payment for MTM and random sample </li></ul></ul><ul><ul><li>132 respondents </li></ul></ul><ul><ul><li>20 payers were selected for participation in an in-depth telephone interview (represented 18 distinct organizations) </li></ul></ul>APhA MTM Digest Survey Methods
  28. 28. <ul><li>MTM services are being provided in diverse geographic areas and diverse care settings </li></ul><ul><li>MTM services are being offered and provided to patients in diverse populations (Medicaid, Medicare, commercial insured, self-insured, etc.) </li></ul><ul><li>Payers and providers anticipate positive impact of MTM on quality and value </li></ul>Overall APhA Survey Findings Schommer JC, Planas LG, Johnson KA, et al. Pharmacist-provided medication therapy management (part 1): provider perspectives in 2007. J Am Pharm Assoc. 2008;48:354 – 63. Schommer JC, Planas LG, Johnson KA, et al. Pharmacist-provided medication therapy management (part 2): payer perspectives in 2007. J Am Pharm Assoc. 2008;48:478 –86.
  29. 29. <ul><li>10 respondents reported ROI for MTM programs </li></ul><ul><ul><li>Ranged from 2:1 to 12:1 </li></ul></ul><ul><ul><li>Median of 3:1 </li></ul></ul><ul><li>Reported actual amounts saved </li></ul><ul><ul><li>$700,000/yr for 200 patients </li></ul></ul><ul><ul><li>(insurer/MTM vendor company) </li></ul></ul><ul><ul><li>$4.5 million/yr (self-insured employer) </li></ul></ul>APhA Survey Findings of the Payer Perspective on Return on Investment (ROI) images Schommer JC, et al. Pharmacist-provided medication therapy management (part 2): Payer perspectives in 2007. J Am Pharm Assoc. 2008;48:478 –86.
  30. 30. APhA Survey Findings of Health Care Measures/Needs Addressed by MTM Services Schommer JC, Planas LG, Johnson KA, et al. Pharmacist-provided medication therapy management (part 2): payer perspectives in 2007 . J Am Pharm Assoc. 2008;48:478 –86.
  31. 31. APhA Survey Findings of Impact of MTM on Future Outcomes Schommer JC, Planas LG, Johnson KA, et al. Pharmacist-provided medication therapy management (part 2): payer perspectives in 2007 . J Am Pharm Assoc. 2008;48:478 –86.
  32. 32. Considerations for Providing MTM Services <ul><li>Any patient who wants/needs MTM services should have access </li></ul><ul><li>Comprehensive Medication Therapy Reviews at least yearly – “Annual Medication Check-Up” </li></ul><ul><li>Targeted Medication Therapy Reviews available as needed to meet the needs of the individual patient </li></ul><ul><li>Additional MTM services should be considered for those patients needing them to maximum your ROI </li></ul>
  33. 33. Our MTM Service Offering <ul><li>Medication Therapy Reviews (using the established MTM Core Elements Service Model) </li></ul><ul><ul><li>Comprehensive Medication Therapy Reviews </li></ul></ul><ul><ul><li>Targeted Medication Therapy Reviews </li></ul></ul><ul><li>Adherence Services </li></ul><ul><li>Targeted Medication Intervention Programs </li></ul><ul><li>Disease State Management </li></ul><ul><ul><li>Diabetes, Asthma, Cholesterol </li></ul></ul><ul><li>Health and Wellness Services </li></ul><ul><ul><li>Wellness screenings </li></ul></ul><ul><ul><li>Immunizations </li></ul></ul><ul><ul><li>Smoking Cessation </li></ul></ul>
  34. 34. [Insert Name of the MTM Practice (Pharmacy or Pharmacist)] <ul><li>[insert content] </li></ul>
  35. 35. Billing, Compensation, and Reporting <ul><li>Billing </li></ul><ul><ul><li>Covered by some insurance plan, else self-pay </li></ul></ul><ul><li>Compensation </li></ul><ul><ul><li>Contact us for details, plans range depending on number of patients and types of services provided. </li></ul></ul>
  36. 36. Billing, Compensation, and Reporting <ul><li>[insert content] </li></ul>
  37. 37. Together we can… <ul><li>Reduce the risk caused by medication-related problems </li></ul><ul><li>Improve care and outcomes </li></ul><ul><li>Help you reduce the health care costs </li></ul><ul><li>Optimize medication use and improve patients’ quality of life </li></ul>
  38. 38. Contact Information <ul><li>Medication Therapy Services, LLC </li></ul><ul><li>235 Greenwood Street, Cranston, RI 02910 </li></ul><ul><li>Phone 401-484-1479 </li></ul><ul><li>Fax 401-270-0378 </li></ul><ul><li>[email_address] </li></ul>
  39. 39. Appendix to Slide Set (use/modify/incorporate into slide set if desired) <ul><li>Patient Case Example </li></ul><ul><li>Clinical Outcomes Example </li></ul><ul><li> Economic Outcomes Example </li></ul><ul><li>Billing, Compensation, and Reporting Example </li></ul>
  40. 40. Clinical Outcomes of MTM Asthma Patients Bunting BA, Cranor CW. The Asheville Project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma. J Am Pharm Assoc. 2006;46:133–47. Link to full text: http://japha.metapress.com/link.asp?id=vr845p3l32384830
  41. 41. Economic Outcomes of MTM Decrease in yearly Rx cost to health plan (N = 7 patients) Rx cost to patient/year (N = 7 patients) McCarthy RA, Bennett MS, Green CG. Abstract: Medication therapy management services for a non-Medicare population: short-term assessment of economic, clinical, and humanistic outcomes. http://www.glprc.com/Abstracts/rptAbstracts%202006.pdf.

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