Pharmacies

Ten Best Practices for Success in Medication Therapy Management

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Here’s how MTM services can help boost patient engagement and pharmacy value.

Medication-related problems impact public health on a huge scale. The American Pharmacists Association reports an estimated 1.5 million preventable adverse drug events each year in the United States at a cost of $177 billion in injury and death.1

Medication therapy management (MTM) presents an opportunity for pharmacies to address the issue by directly engaging chronically ill patients. Specifically, MTM enhances patient understanding of their medications, improves adherence, provides the right drug to the right patient and prevents adverse reactions. Nearly 300 published studies show that pharmacist-provided MTM services contribute to significant improvement in outcomes in disease management, cost savings or quality-of-life measures.2

In addition, face-to-face MTM interactions encourage a personalized relationship between patient and pharmacy while allowing the pharmacist to identify patient needs and helpful services.

MTM status
Medicare’s 2016 Star Ratings program includes a new process measure, MTM Program Completion Rate for Comprehensive Medication Reviews (CMRs), which plays a part in determining how highly a health plan will be rated on continuous quality improvement in patient care and outcomes. The measure applies to health plan members who had a pharmacist (or other health professional) help them understand and manage their medications. It indicates how many eligible members in an MTM program completed a CMR from the plan during a reporting period.

Medicare envisions CMRs as targeted medication reviews being performed by pharmacists, during which they have in-person visits or real-time phone conversations with patients. The goal is to create an environment for the patient to be educated on his or her medications and disease states.

Looking at the 2016 ratings, which reflect 2014 data, Medicare Advantage with Prescription Drug (MA-PD) plans averaged a CMR completion rate of 30.9 percent. Part B Prescription Drug-Only (PDP) plans averaged 15.4 percent.3 For each category, the average performance qualifies as a two Star rating, leaving much room for improvement:

KD_cutpoints _chart

Although we anticipate an uptick in the percentage of cases being completed when more recent data are released, many pharmacies are not currently completing their assigned cases and a large number are not even enrolled to provide MTM services to their patients.

Best practices in the MTM process
With patient engagement and performance improvement in mind, let’s examine what pharmacies can be doing now to prepare for provision of MTM services, and how they can excel once their program is up and running. Consider these 10 recommendations:

  1. Get enrolled. Approximately 80 percent of the Medicare plans across the country use an MTM vendor to fulfill their cases.4 Mirixa® and OutcomesMTM®, two of the most prominent vendors, offer online sign-ups for pharmacies interested in using their respective MTM platforms. At the moment, only about 28 percent of independent community pharmacists have access to the cases flowing through MTM vendor platforms,5 so there’s ample opportunity to get involved. 
  2. Instill consistency. Set aside certain days of the week conducive to the pharmacy’s schedule to work on MTM cases. At Moundsville Pharmacy, where I practice, we check the MTM platform for new assigned cases and due dates once per week — each Monday — and then schedule CMR sessions for Thursdays and Fridays on an ongoing basis.
  3. Assume acceptance. Scheduling patients for CMR sessions should be a matter of when, not if. Look at the patient’s medication profile before calling to determine when he or she is most likely to be visiting the pharmacy. Perhaps the patient is due to pick up chronic medications or has them in will-call status. A simple, specific request might go like this: “I know you have a prescription ready for pick-up on Thursday. Would you be able to meet with me that morning?” The key is to put patients in position to complete — rather than opt out of — the CMR process.
  4. Schedule strategically. We’ve found a “sweet spot” in calling patients two to three days in advance of the desired CMR date. Longer lead times increase the chance that the patient may forget the appointment or that a conflict may arise in the pharmacy’s schedule. 
  5. Leverage technology and staff. Outbound CMR scheduling calls often go unanswered or transfer to voice mail. As such, they should be documented in the pharmacy’s software program’s patient profile “notes” field (e.g., “LM to discuss statin omission”). Pharmacy technicians or students who handle callbacks can use this information to help schedule patients and advocate for MTM. Detailed discussions on drug therapy can be referred to any available pharmacist.
  6. Be prepared. Upon assignment of a new MTM case, review the patient’s profile and enter notes regarding issues that should be addressed during the session. For instance, the profile may indicate that the patient is not up to date on applicable vaccines. Add notes for any additional services to be discussed when face-to-face with the patient. At Moundsville, we print off a summary sheet corresponding to each MTM case and place it in a folder at the front counter. This helps staff respond effectively when fielding MTM callbacks by giving them immediate access to patient-relevant information.
  7. Add automation. Explore the capabilities of the MTM platform to help streamline pharmacy workflow. For example, one platform recently added a feature that generates editable, pre-populated clinical text specific to the patient’s disease state for inclusion in the Medication Action Plan. From a broader view, each of the platforms offers screens for tracking MTM case assignments and status.
  8. Plant the seed. Some pharmacies feel challenged to complete MTM services for patients who routinely fill their prescriptions at other stores. When calling such patients, explain that CMR is a free service recommended by their health insurance plan and clarify that they won’t be pressured to transfer their existing prescriptions. Subsequently, the pharmacy’s chance to shine comes once the actual visit begins. That’s the time to introduce available services that may be beneficial and immediately available — and get patients thinking about returning in the future.
  9. Request medication bottles. When dealing with patients not seen on a regular basis, ask that they bring their medication containers to the CMR appointment. Directly viewing the labels enables the pharmacist to accurately document medication strength and directions. Additionally, when patients get into the flow of conversation about their medications, they often express what’s challenging or frustrating about their current pharmacy experiences. Perhaps they have to make multiple trips per month to fill their prescriptions. That’s an opening to talk about the advantages of medication synchronization and ease of enrollment in such a program.
  10. Make steady progress. Find a comfortable balance in taking action on assigned MTM cases. On one hand, it’s not recommended to let assignments back up until the plan issues a deadline warning. But at the same time, the pharmacy shouldn’t feel pressured to complete cases the same week they’re assigned. A reasonable workflow design and strategy supports continuous progress. At Moundsville, our goal is to call three to five assigned patients weekly to either schedule CMRs or discuss interventions. Most plans identify MTM patients quarterly, so expect two to four periods per year when a large number of cases will be assigned. Conditions will vary from pharmacy to pharmacy, but be sure to track completion and recognize success with staff along the way.

Prove your pharmacy’s value
The MTM service can have tremendous impact for the patient, but pharmacists and pharmacy owners also need to recognize the business value that can be attained beyond the one-time fee for case completion.

For example, identifying a patient recommended for statin therapy may result in 12 more 30-day prescription fills of that medication annually. Similarly, enrolling a patient in a medication synchronization program brings the potential to fill 20 more prescriptions per year.6 Other services that may come into play include compression stockings (two to four times annually) for diabetic patients, or vaccinations on a seasonal (e.g., flu) or year-round basis (e.g., shingles, pneumonia or Tdap booster). Durable medical equipment (e.g., walkers, shower chairs, canes) can be provided for patients with health difficulties at home.

Pharmacists should be taking full advantage of the opportunity to engage with chronically ill patients identified by Medicare as being eligible for MTM services. Doing so not only fulfills the primary roles of MTM in education and detecting drug interactions and duplications — as well as identifying omissions in therapy and high-risk medications — but also highlights additional pharmacy services that help make patients healthier and happier.

References

1. APhA MTM Central. Why is medication therapy management needed? http://www.pharmacist.com/mtm

2. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. U.S. pharmacists’ effect as team members on patient care: systemic review and meta-analysis. Medical Care. October 2010. https://www.ncbi.nlm.nih.gov/pubmed/20720510

3. Pharmacy Quality Alliance. Update on medication quality measures in Medicare Part D plan Star Ratings – 2016. http://pqaalliance.org/measures/cms.asp

4. Centers for Medicare and Medicaid Services. 2015 Medicare Part D medication therapy management (MTM) programs. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/CY2015-MTM-Fact-Sheet.pdf

5. ibid.

6. National Community Pharmacists Association. Patients benefit from pharmacy-provided medication synchronization programs. http://www.ncpanet.org/newsroom/news-releases/2014/01/15/patients-benefit-from-pharmacy-provided-medication-synchronization-programs






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