medication therapy management: if you build it, they will come
DESCRIPTION
Medication Therapy Management: If You Build It, They Will Come. Meghan K. Sullivan, Pharm.D . Assistant Professor University of New England College of Pharmacy July 27, 2012. Learning Objectives. - PowerPoint PPT PresentationTRANSCRIPT
MEGHAN K. SULLIVAN, PHARM.D.ASSISTANT PROFESSOR
UNIVERSITY OF NEW ENGLAND COLLEGE OF PHARMACY
JULY 27 , 2012
Medication Therapy Management: If You Build It,
They Will Come
Learning Objectives
Discuss the history of Medication Therapy Management (MTM): where have we been, and where we are going.
Describe the various core components of MTM, including: medication therapy review (MTR), personal medication record (PMR), medication action plan (MAP), intervention and/or referral, documentation, follow-up and billing.
Discuss the current marketplace for MTM services.
Discuss the design, development, implementation, sustainability and measures for continuous quality improvement revolving around MTM services.
Evaluate current, and discuss future, reimbursement strategies for MTM services.
Defining MTM
“A service or group of services that optimize therapeutic outcomes for individual patients.” - Pharmacy Profession (2004)
“A program of drug therapy management that may be furnished by a pharmacist and is designed to assure, with respect to targeted beneficiaries, that covered Part D drugs are appropriately used to optimize therapeutic outcomes through improved medication use, and to reduce risk of adverse events including adverse drug interactions.” – CMS (2005)
MTM 101
Core Elements of an MTM Service Model
Medication therapy review (MTR)
Personal medication record (PMR)
Medication-related action plan (MAP)
Intervention and/or referral
Documentation and follow-up
American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008. Available at: www.pharmacist.com/MTM. Accessed December 19, 2011.
Medication Related Problems
Unnecessary Drug Therapy
Wrong Drug
Incorrect Dose
Adverse Drug Reaction
Inappropriate Compliance
Needs Additional TherapyAmerican Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication Therapy Management in
Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008. Available at: www.pharmacist.com/MTM.
Accessed December 19, 2011
Testing Your Knowledge…
LB is a 72-year old female who presents to your pharmacy for a MTM consultation. During your visit, you discover that she only takes her hydrochlorothiazide “occasionally” when she notices swelling in her legs, as she experiences nocturia when taking it daily. When completing her MAP, how should this medication-related problem be classified?1. Appropriateness of dose/dosing regimen2. Therapeutic duplication3. Untreated disease/condition4. Adherence to therapy
MTM Services Business Model
American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication Therapy
Management in Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008. Available at:
www.pharmacist.com/MTM. Accessed December 19, 2011.
Treatment Population
“MTM services should be considered for any patient with actual or potential medication-related problems.” – MTM Core Elements 2.0
Medication Therapy Management Services
Medication Therapy Reviews
Pharmacotherapy Consults
Disease state management
Pharmacogenomics
Medication safety and surveillance
Health and wellness
Anticoagulation management
Immunizations
American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication Therapy
Management in Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008. Available at:
www.pharmacist.com/MTM. Accessed December 19, 2011.
Medication Therapy Management Providers
American Pharmacists Association. Medication Therapy Management Digest. Tracking the Expansion of MTM in 2010: Exploring the Consumer Perspective. March 2011. Available at: http://www.pharmacist.com/AM/Template.cfmSection=MTM&TEMPLATE=CMContentDisplay.cfm&CONTENTID=25712. Accessed: July 7, 2012.
Pharmacists in-house
Contracted Pparmacists
Contracted MTM provider organization
Nurses in-house
Other
Contracted physicians
Disease management vendor
Contracted nurse
0 10 20 30 40 50 60 70
200820092010
MTM Patient Care Settings
American Pharmacists Association. Medication Therapy Management Digest. Tracking the Expansion of MTM in 2010: Exploring the Consumer Perspective. March 2011. Available at: http://www.pharmacist.com/AM/Template.cfmSection=MTM&TEMPLATE=CMContentDisplay.cfm&CONTENTID=25712. Accessed: July 7, 2012.
Chain pharmacy
Independent pharmacy
Ambulatory care/outpatient
Acute care inpatient
Managed care/PBM
Federal pharmacy
Other
0 5 10 15 20 25 30 35 40
200820092010
MTM Payment: Not Just for Medicare Beneficiaries!
Medicare Advantage plans
Medicare stand-alone prescription drug plans
HMO/managed care plans
Specific employer benefit group
Commercial insurance
PPO plans
State Medicaid programs
Self-insured health or prescription coverate
Health savings accountsAmerican Pharmacists Association. Medication Therapy Management Digest. Tracking the Expansion of MTM in 2010: Exploring the Consumer Perspective. March 2011. Available at: http://www.pharmacist.com/AM/Template.cfm?Section=MTM&TEMPLATE=CMContentDisplay.cfm&CONTENTID=25712. Accessed: July 7, 2012.
The MTM Movement
The MTM Movement
2006: Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) Medicare Advantage-Prescription Drug Plans (MA-PD) Prescription Drug Plans (PDP)
CMS mandated that MTM must “evolve and become the cornerstone of the Medicare Prescription Drug Benefit”
Centers for Medicare and Medicaid Services. Medicare Prescription Drug Benefit; Final Rule. Issued January 28, 2005. Available at: http://www.access.gpo.gov/su_docs/fedreg/a050128c.html. Accessed December 17, 2012.
The MTM Movement
Medication-related problems Annual preventable medication ADRs: 1.5 million Annual health care system expenditures: $178 billion
Medicare population Average of 5 or more medications Increased risk for medication-related problems
Initial MMA MTM Beneficiary Requirements
Multiple chronic disease states
Medication therapy including multiple Part D covered drugs
Patient likely to incur annual costs for Part D drugs that exceed a predetermined level: $4,000
Centers for Medicare and Medicaid Services. Medicare Prescription Drug Benefit; Final Rule. Issued January 28, 2005. Available at: http://www.access.gpo.gov/su_docs/fedreg/a050128c.html . Accessed December 17, 2012.
Enhancement of Medicare Part D MTM Programs
Affordable Care Act (2010) Improved access to MTM services
Increased intensity of interventions
Provision of summaries to beneficiaries
Collection of robust data for outcomes analysis
Centers for Medicaid and Medicare. 2011 Medicare Part D Medication Therapy Management (MTM) Programs. Issued June 30, 2011. Available at:https://www.cms.gov/PrescriptionDrugCovContra/Downloads/MTMFactSheet2011063011Final.pdf Accessed January 3, 2012
Medicare Part D MTM Programs on the Horizon
Changes for 2013: MTM services and strategies MUST include:
Annual Comprehensive Medication Review
Follow-up interventions
Quarterly assessment of medication use
Automatic enrollment of targeted beneficiaries
Standardized format for comprehensive medication review, action plan and summary
Centers for Medicaid and Medicare. CY 2013 Medication Therapy Management Program Guidance and Submission Instructions. Issued April 12, 2012. Available athttps://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/Memo-Contract-Year-2013-Medication-Therapy-Management-MTM-Program-Submission-v041012.pdf. Accessed July 7, 2012.
Health Care Reform and More!
Accountable Care Organizations
Patient-centered Medical Home
“Independence at Home”
Transitions of Care ActivitiesAmerican Pharmacists Association; APhA Pharmacy Law Matters 2010: Focus on Selected Provisions of the
Affordable Care Act. Pharmacy Today. December 2010. Available at: http://208.40.175.32/cecity/components/util/pdf/docs/pdf/15288_print.pdf. Accessed July 7, 2012.
Testing Your Knowledge…
As per the Medicare Prescription Drug, Improvement and Modernization Act of 2003, how frequently are Medicare Part D plan sponsors required to offer a comprehensive medication review? 1. Quarterly2. Bi-annually3. Annually4. Every 5 years
Building Your Service
Developing Your Business Plan
Mission statement, goals, objectives
Target population(s)
Desired MTM services
Implementation strategy
Evaluation strategy
MTM Implementation SWOT Analysis
Strengths
Weaknesses
Opportunities
Threats
Internal Factors
External Factors
Setting Goals
SMART Goals Specific
Measurable
Achievable
Realistic
Time-Limited
Practice Site Operation Considerations
Space Layout
Legal, regulatory and quality measures
Workflow Assigned duties/tasks
Personnel
Time
Budget Rent/Utility Costs
Software
Vendor contracts
Marketing/Advertising
Personnel
Pharmacists Pharmacy Technicians
Manager, RPh, clinical pharmacy specialist
Training APhA, ASHP, NCPA, ASCP,
ACCP, CCGP, BPS MTM, clinical skills,
assessment and evaluation
MOTIVATION/Incentive
Marketing
Recruitment
Scheduling
Documentation/Data Entry
Billing
Pharmacy Personnel
Testing Your Knowledge…
Which of the following MTM consultation activities are appropriate for pharmacy technicians to participate in? 1. Establishing appointments with patients2. Billing third-party payers for MTM consultations3. Faxing/mailing follow-up documentation forms
to health care providers4. All of the above
Planning for MTM Consultations
Appointment Availability Personnel
Pharmacist hours Pharmacy technician hours Admin/clerk hours
Workload Daily script count
Interaction Face-to-face Telephonic
Recruitment of MTM Patients
Local Initiative Identifying standards
Sorting data
Contact patients
MTM Vendors Pharmacy network
Contact patients
30-90 day turn-around
Documentation of MTM Consultations
Paper patient charts
Internal documentation system
Electronic medical record (EMR)
MTM vendor software
Available Electronic Documentation Systems:
Community CCRx HealthMap Rx MedKeeper MirixaPro MTMPath Outcomes Pharmaceutical
Health Care Patient Tracker PharmMD PhillHelpWorks RxPerise
Marketing for MTM Services
Media: TV, radio, newspaper
Social Networking: Facebook, Twitter
Fliers, bag-stuffers, buttons, vial caps, stickers
Education!
Testing Your Knowledge
List four ways that you can promote MTM services:1. 2. 3. 4.
MTM Consultations
Pre-appointment: Review patient materials
Document initial findings
Identify points of clarity
Appointment: Completion of MTR, PMR,
MAP
Post-appointment: Follow-up: how often?
Billing for MTM Services
CPT Codes for MTM 99605: Initial patient
consultation: Max. 15 minutes
99606: Follow-up patient consultation: Max. 15 minutes
99607: Can be used in combination with either 99605 or 99606 to bill for any additional time spent with the patient, in 15 minute increments.
“Incident to” evaluation and management codes (E&M) codes 99211
Completing the process… National Provider
Identifier
Superbills
Testing Your Knowledge…
Which of the following CPT codes should be used to bill for additional 15 minute increments during an initial or follow-up MTM consultation1. 996042. 996053. 996064. 99607
IS IT WORTH ALL OF YOUR EFFORT?!
Make it Work!
Return on Investment
Sample Business Model: Pharmacist: $130,000
Base salary: $100,000 Benefits: $30,000
Full time employment: 2000 hrs/annually
Need to generate $65/hour if hired as MTM pharmacist
Is it worth it?!McDonough R. Making an MTM business plan work. Pharmacy Today. 2011;17: 48
Institutional Pharmacy Study
Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System
Methods: retrospective review of 9,068 patients receiving MTM services from September 1998 to 2008 Patients 21 years of age and older were eligible Payment made out of pocket or via third party payer Cost-savings calculations based on estimated costs of office
visits, laboratory services, urgent care and emergency room visits and missed days of work
Ramalho de Oliveira D, Brummel A, Miller D. Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System. Journal of Managed Care Pharmacy. 2010;16:185-195
Institutional Pharmacy Study
Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System
Results: Patients: 9,068 Documented encounters: 33,706 Drug therapy problems identified: 38,631 Patients not a goal: 4,849 (12,851 conditions)
Improved: 7,068, No Change: 2956, Worsened: 2,827 Cost Savings: $2,913,850 ($86/encounter)
Cost of MTM $2,258,302 ($67/encounter) ROI: $1.29 per $1 spent
Ramalho de Oliveira D, Brummel A, Miller D. Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System. J Manag Care Pharm. 2010;16:185-195
Community Pharmacy Study
Analysis of Pharmacist-Provided Medication Therapy Mangement (MTM) Services in Community Pharmacies Over 7 Years
Methods: MTM claims data from a multistate MTM vendor was analyzed: Reason, Action, Result, Estimated Cost Avoidance (ECA)
Barnett J, Frank J, Wehring H, et.al. Analysis of Pharmacist-Provided Medication Therapy Mangement (MTM) Services in Community Pharmacies Over 7 Years. J Manag Care Pharm. 2009;15:18-30
Community Pharmacy Study
Analysis of Pharmacist-Provided Medication Therapy Mangement (MTM) Services in Community Pharmacies Over 7 YearsResults:
Number of claims in database: 100,000 Claims analyzed: 76,148 (23,798 patient) Average pharmacy reimbursement: $8.44/MTM
service Mean ECA: $93.78 Trends resulted in higher pharmacy reimbursements
and greater ECA per claim over time (P<0.001)Barnett J, Frank J, Wehring H, et.al. Analysis of Pharmacist-Provided Medication Therapy Mangement (MTM) Services in Community Pharmacies Over 7 Years. J Manag Care Pharm. 2009;15:18-30
Questions?!
MEGHAN K. SULLIVAN, PHARM.D.ASSISTANT PROFESSOR
UNIVERSITY OF NEW ENGLAND COLLEGE OF PHARMACY
JULY 27 , 2012
Medication Therapy Management: If You Build It,
They Will Come