MTM Presentation

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MTM Presentation

  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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