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  • 1. Pharmacists Improving Care and Reducing Costs image001 logo
  • 2. Medication Therapy Management, LLC
    • Medication Therapy Services, LLC 235 Greenwood Street, Cranston, RI 02910 Phone 401-484-1479 * Fax 401-270-0378
    • Team of specially trained pharmacists
    • 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.
  • 3. Scope of Medication-Related Problems
    • Significant impact on public health resulting from medication-related injury and death
    • More than 1.5 million preventable medication-related adverse events occur each year
    • Inappropriate use of medications costs an estimated $177 billion annually
    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. 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. What Is Medication Therapy Management (MTM)?
    • 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.
  • 6.
    • Who Needs Medication Therapy Management?
    MPj04223650000[1] understanding-diabetes-ga-2 Business-People asthma_child140
  • 7. Where Are You Spending Your Health Care Dollars? Kaiser Family Foundation, 2007. http://www.kff.org/insurance/index.cfm
  • 8. The Spectrum of Pharmacist-Provided MTM
    • Comprehensive or Targeted Medication Therapy Reviews
    • Adherence Services
      • Based on the number and/or type of medications
    • Targeted Medication Intervention Programs
      • High-alert and/or high-cost medications
      • Targeted patient population (i.e. geriatrics, pediatrics)
    • Disease State Management
      • Interdisciplinary approach to achieve therapeutic goals
      • Example disease states: Diabetes, Cholesterol, Asthma
    • Health and Wellness Services
      • Wellness screenings
      • Smoking cessation
  • 9. MTM Core Elements Service Model Core Elements
    • Developed by the American Pharmacists Association and the National Association of Chain Drug Stores Foundation
    • Supported by 10 national pharmacy organizations
  • 10. Components of the MTM 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
  • 11. Medication Therapy Reviews
    • A Medication Therapy Review (MTR) is a “Medication Check-Up” 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
    photo_06_News
  • 12. What Do Patients Get From Care Aligned With the MTM 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)
  • 13. Examples of MTM Interventions
    • Medication Adherence
      • Medication-related problem
        • Overuse of albuterol inhaler and suboptimal use of inhaled steroids in the treatment of asthma
      • Impact of MTM
        • Reduce ER visits, hospitalizations
    • Medication Interactions
      • Medication-related problem
        • Use of medications that can potentially increase the effect of warfarin (blood thinner)
      • Impact of MTM
        • Reduce risk of bleeding events, ER visits, and hospitalizations
  • 14. Examples of MTM Interventions
    • Missing Therapy
      • Medication-related problem
        • Lack of therapy recommended by treatment guidelines
      • Impact of MTM
        • Better care and outcomes in alignment with evidence-based guidelines
    • Duplicate Medication Therapy
      • Medication-related problem
        • Two or more drugs treating the same condition
      • Impact of MTM
        • Coordination of care with multiple health care providers
        • Reduced risk of over-dosing due to additive effects
  • 15. A Case Example From Our Practice
    • 55 yo male with Type 2 Diabetes
    • Duplication of Therapy: Prescribed two ACE inhibitors
      • Primary Care Physician (PCP): Lisinopril
      • Endocrinologist: Ramipril
    • Contacted both prescribers to make them aware of this medication related problem
    • Patient was continued on Ramipril
  • 16. A Case Example From Our Practice
  • 17. Goals of MTM Services
    • Patients
      • More medication-related problems identified and resolved
      • Empowered to take an active role in their medication management
    • Health Care Professionals
      • Improved transitions and continuity of care
      • Improved medication use outcomes
    • Payers
      • Reduction in adverse drug events
      • Potential to lower health care costs
  • 18. MTM Services In Action
    • Minnesota Medication Therapy Management Care Program
    • The Asheville Project
  • 19. Clinical Outcomes of MTM Minnesota MTM Care Program
    • 3.1 drug therapy problems identified and resolved per recipient
    • Most common drug therapy problems:
      • Dosage too low
      • Non-compliance
      • Need for additional drug therapy
    • Diabetes Subset (114 recipients):
      • 36% of patients with diabetes met all five of the state’s quality standards
      • Average hemoglobin A 1 C value was 7.38% (range 4.9%-14.7%, std dev. =1.82%)
      • 77% (88/114) of recipients with diabetes achieved hemoglobin A 1 C benchmark goal (less than or equal to 8%)
    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. 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. 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. 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. Economic Outcomes of MTM Minnesota Medicaid MTM Care Program Decrease in :
    • Prescriber & non-prescriber provider costs
    • Ambulatory care costs
    • Lab & Diagnostic costs
    • Other costs
    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. 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. 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.
    • American Pharmacists Association survey of pharmacist providers and payers
      • MTM implementation strategies
      • Value of MTM services
    • www.pharmacist.com/MTM
    APhA MTM Digest Examining the Value of MTM Services
  • 27.
    • Providers
      • E - mail survey conducted November/December 2007
      • Distributed to 6,873 providers who were likely to be involved with providing MTM
      • 687 respondents
    • Payers
      • E-mail survey conducted November/December 2007
      • Distributed to 1,898 individuals who were likely to be involved with payment for MTM and random sample
      • 132 respondents
      • 20 payers were selected for participation in an in-depth telephone interview (represented 18 distinct organizations)
    APhA MTM Digest Survey Methods
  • 28.
    • MTM services are being provided in diverse geographic areas and diverse care settings
    • MTM services are being offered and provided to patients in diverse populations (Medicaid, Medicare, commercial insured, self-insured, etc.)
    • Payers and providers anticipate positive impact of MTM on quality and value
    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.
    • 10 respondents reported ROI for MTM programs
      • Ranged from 2:1 to 12:1
      • Median of 3:1
    • Reported actual amounts saved
      • $700,000/yr for 200 patients
      • (insurer/MTM vendor company)
      • $4.5 million/yr (self-insured employer)
    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. 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. 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. Considerations for Providing MTM Services
    • Any patient who wants/needs MTM services should have access
    • Comprehensive Medication Therapy Reviews at least yearly – “Annual Medication Check-Up”
    • Targeted Medication Therapy Reviews available as needed to meet the needs of the individual patient
    • Additional MTM services should be considered for those patients needing them to maximum your ROI
  • 33. Our MTM Service Offering
    • Medication Therapy Reviews (using the established MTM Core Elements Service Model)
      • Comprehensive Medication Therapy Reviews
      • Targeted Medication Therapy Reviews
    • Adherence Services
    • Targeted Medication Intervention Programs
    • Disease State Management
      • Diabetes, Asthma, Cholesterol
    • Health and Wellness Services
      • Wellness screenings
      • Immunizations
      • Smoking Cessation
  • 34. [Insert Name of the MTM Practice (Pharmacy or Pharmacist)]
    • [insert content]
  • 35. Billing, Compensation, and Reporting
    • Billing
      • Covered by some insurance plan, else self-pay
    • Compensation
      • Contact us for details, plans range depending on number of patients and types of services provided.
  • 36. Billing, Compensation, and Reporting
    • [insert content]
  • 37. Together we can…
    • Reduce the risk caused by medication-related problems
    • Improve care and outcomes
    • Help you reduce the health care costs
    • Optimize medication use and improve patients’ quality of life
  • 38. Contact Information
    • Medication Therapy Services, LLC
    • 235 Greenwood Street, Cranston, RI 02910
    • Phone 401-484-1479
    • Fax 401-270-0378
    • [email_address]
  • 39. Appendix to Slide Set (use/modify/incorporate into slide set if desired)
    • Patient Case Example
    • Clinical Outcomes Example
    • Economic Outcomes Example
    • Billing, Compensation, and Reporting Example
  • 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. 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.