mtm presentation

8/14/2019 MTM Presentation

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CollaboratorsCollaborators

We share an office at Gateway FamilyWe share an office at Gateway FamilyHealth Clinic in Moose Lake.Health Clinic in Moose Lake.

We share patient management.We share patient management.We share information & ideas.We share information & ideas.


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Todays presentation:Todays presentation:Physician and Pharmacist CommunicationPhysician and Pharmacist Communication

ininMedication Therapy ManagementMedication Therapy Management

We address:We address:The communications past The communications past

The communications present The communications present

The communications possible future:The communications possible future:Medication Therapy Management.Medication Therapy Management.


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The communications past The communications past

Physicians phoned the pharmacist for prescribingPhysicians phoned the pharmacist for prescribingadvice.advice.

Physicians visited the pharmacy - a social get away fromPhysicians visited the pharmacy - a social get away fromthe grind.the grind.

Pharmacists and physicians had coffee breaks together.Pharmacists and physicians had coffee breaks together.Physicians were welcome behind the pharmacy counter.Physicians were welcome behind the pharmacy counter.

Pharmacists and physicians exchanged professionalPharmacists and physicians exchanged professionalcourtesy; they did not charge each other.courtesy; they did not charge each other.

The number of prescriptions filled in a day at a pharmacyThe number of prescriptions filled in a day at a pharmacywas manageable.was manageable.


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J.K. Kallail studied the communications present.J.K. Kallail studied the communications present. Kallail, J.K.et. al., in Pharmacy-Physician Communications. Journal of the AmericanKallail, J.K.et. al., in Pharmacy-Physician Communications. Journal of the American

Pharmacists Association, Sept/Oct 2006, Vol. 46, No. 5, pp 618-20.Pharmacists Association, Sept/Oct 2006, Vol. 46, No. 5, pp 618-20.

Pharmacist - physician communications breakdown:Pharmacist - physician communications breakdown:

95%: for a refill (fax or electronic).95%: for a refill (fax or electronic).1.3%: omitted information on a prescription. (quantity;1.3%: omitted information on a prescription. (quantity;directions; etc.)directions; etc.)

1.7%: Need information (a license number - etc. - of the1.7%: Need information (a license number - etc. - of thephysician.physician.

1.7%: Pharmacy recommends a non clinically relevant1.7%: Pharmacy recommends a non clinically relevantchange in the prescription.change in the prescription.

0.16%: Pharmacy recommends clinically relevant0.16%: Pharmacy recommends clinically relevant

prescription change.prescription change.


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Possible reasons 0.16% of communicationsPossible reasons 0.16% of communicationshave clinical relevance:have clinical relevance:

Number of prescription numbers filled hasNumber of prescription numbers filled has

soared.soared.Pharmacist numbers have not proportionallyPharmacist numbers have not proportionallysoared.soared.

Costs have soared.Costs have soared.

Prescription advice is given at the pharmacy -Prescription advice is given at the pharmacy -but it is not well coordinated with the physician.but it is not well coordinated with the physician.


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The communications possible future:The communications possible future:

MTM.MTM.MTM: Optimizing therapeutic outcomes forMTM: Optimizing therapeutic outcomes forindividual patients.individual patients.

Ashville: includes an MTM model that fostersAshville: includes an MTM model that fosters

communication between physician andcommunication between physician andpharmacist.pharmacist.

Overall better health of patients.Overall better health of patients.

Overall increased prescription use.Overall increased prescription use.

Reduced non-prescription health costs.Reduced non-prescription health costs.Overall reduced costs.Overall reduced costs.

Non-prescription health costs over-rideNon-prescription health costs over-rideincreased prescription costs.increased prescription costs.


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Overall increased prescriptionOverall increased prescription

use.use.Decreased cost withDecreased cost with increasedincreased prescriptionprescriptionuse?use?

Patients were taking the medications theyPatients were taking the medications theyneeded.needed.

They became healthier.They became healthier.

They stayed out of the hospital.They stayed out of the hospital.Costs went down.Costs went down.

The cost reduction from non-medication costsThe cost reduction from non-medication costsoutweighed the cost increase of increaseoutweighed the cost increase of increase

prescription use.prescription use.


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An AnimationAn Animation

(based upon trends to give a visual.)(based upon trends to give a visual.)

Time period before 2008: the soaringTime period before 2008: the soaringcosts.costs.

Time period after 2008: what couldTime period after 2008: what couldhappen by applying an MTM model.happen by applying an MTM model.

First, watch each of the five variablesFirst, watch each of the five variablesmove over time.move over time.

Then, well slow down the animation.Then, well slow down the animation.


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Change to video setting Change to video setting


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The message:The message:

MTM improves health & reduces costs.MTM improves health & reduces costs.

The Orange bubble (total costs) and GreenThe Orange bubble (total costs) and Green

bubble (pharmacy input - MTM) like to bebubble (pharmacy input - MTM) like to betogether.together.


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January 2008

Asheville Total Health Care CostsAsheville Total Health Care Costs11

11Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of aCranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of acommunity pharmacy diabetes care program.community pharmacy diabetes care program. J Am Pharm Assoc.J Am Pharm Assoc. 2003;43:173-84.2003;43:173-84.

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

Baseline 1 2 3 4 5

Follow-up Year

Medical $ Diabetes Rx Other Rx


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January 2008

Average Annual Diabetic Sick-LeaveAverage Annual Diabetic Sick-Leave

Usage (City of Asheville)Usage (City of Asheville)

12.6

6

8.46

5.68 5.81 5.67 6.01

0

2

4

6

8

10

12

14


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A little closer to homeA little closer to home

6 Fairview Clinics in the Twin Cities6 Fairview Clinics in the Twin Cities

BCBS members 18 years and olderBCBS members 18 years and older

1 or more of 12 medical conditions1 or more of 12 medical conditions2 or more historical health claims related2 or more historical health claims related

to those medical conditionsto those medical conditions

Pharmacists saw 285 patients in 684Pharmacists saw 285 patients in 684encountersencounters

J Am Pharm Assoc. 2008;48:203211


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March 2008

BCBS Minnesota StudyBCBS Minnesota Study

Economic OutcomesEconomic OutcomesResultsResults

Intervention group prior year expenditures averaged $11,965Intervention group prior year expenditures averaged $11,965and decreased 31.5% to $8,197 post-interventionand decreased 31.5% to $8,197 post-intervention

57.9%57.9% facilitiesfacilities 11.1%11.1% professionalprofessional 19.7%19.7% Rx expendituresRx expenditures

Total health care $Total health care $ 31.5% from $2,225,540 to $1,524,70331.5% from $2,225,540 to $1,524,703a difference of $700,837a difference of $700,837

Cost MTM = $44,528Cost MTM = $44,528

Cost of co-payments, co-insurance and deductibles and 3Cost of co-payments, co-insurance and deductibles and 3rdrdparty payer cost = $104,028party payer cost = $104,028Benefit attributable to MTM = $552,281Benefit attributable to MTM = $552,281

ROI = $12.40 for every $1 investedROI = $12.40 for every $1 invested


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ConclusionsConclusions

Pharmacists and physicians can workPharmacists and physicians can worktogether to improve health and decreasetogether to improve health and decrease

costs for patients with chronic conditionscosts for patients with chronic conditions

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