Insights into Pharmacist Provided MTM Services-Present and Future - - PowerPoint PPT Presentation

Insights into Pharmacist Provided MTM Services-Present and Future

Anne Burns, RPh Vice President, Professional Affairs American Pharmacists Association

Learning Objectives

• Describe the scope of MTM service delivery

around the country.

• Describe the APhA/NACDS Foundation MTM

Core Elements Service delivery model.

• Explain research findings on perspectives of

providers and payers.

• Discuss changes for 2010 Medicare Part D MTM

programs and MTM opportunities under the health care reform bill.

Medication Therapy Management Services: Pharmacy Consensus Definition

• Three inseparable elements:

– Primary Definition: services that optimize

therapeutic outcomes for individual patients…

– Professional Service Components: MTM encompasses a broad range of activities and responsibilities within a pharmacist’s scope of practice… – Program Requirements: MTM Programs shall include (core criteria for an MTM program)…

Bluml, BM. Definition of medication therapy management: development of profession wide consensus.J Am Pharm Assoc. 2005;45:566-72.

Medicare Part D MTM

MTM in Pharmacy Practice

Scope of MTM Delivery in Pharmacy Practice

• Public Sector: Medicare Part D (PDP & MA-PDs)
• Public Sector: State-based Medicaid Programs
• Public Sector: Community Health Centers, VA, IHS
• Private Sector: Self-insured employer groups
• r managed care/health plans

MTM Core Elements Service Model – v2.0

• APhA/NACDS: “baseline”

service model for MTM providers

• Supported by major

national pharmacy associations

• Based on the pharmacy

profession’s MTM Definition

Goals of MTM Core Elements Version 2.0

• Improve collaboration among pharmacists,

physicians, and other health care professionals

• Enhance communication between patients

and their health care team

• Empower patients to optimize medication use

for improved health care outcomes

MTM Core Elements

• Medication Therapy Review (MTR)
• Personal Medication Review (PMR)
• Medication-Related Action Plan (MAP)
• Intervention and/or referral
• Documentation and follow-up

APhA MTM Digest

• Highlights of pharmacist

provider and payer surveys on MTM services

• MTM Definition for survey

= pharmacy profession consensus definition – MTM provided face- to-face and by phone

• New trending graphs

comparing survey data from 2007 and 2008

Survey Goals

• Barriers to implementing MTM services and challenges that arise

during service provision

• Implementation strategies that have been used for providing MTM

services

• The value associated with pharmacist-provided MTM services to

both providers and payers

• Specific measure, if any, used to quantify MTM costs and benefits
• The monitoring of the value of MTM services to providers and payers

Provider Perspectives on Offering MTM Services

• Key factors affecting decision to implement MTM

services: – Patient health needs – Responsibility as a health care provider – Recognized a need to improve health care quality – Contribution to health care team

• Providers’ reasons for offering services tended to be

more professional and altruistic

Consistent theme since 2007

Provider Perspectives on Financial Aspects of MTM

• Most commonly reported investments were staff-related

– Training staff, changing staffing patterns, and increasing number of pharmacists

• An overwhelming majority of providers who received

payment for providing MTM services did so as part of their standard pharmacist salary

• 56% of providers who billed for MTM services used CPT codes

Consistent with 2008 data

Value to Providers from MTM Services

• Factors rated as significant to providers

– Improved professional satisfaction – Improved patient satisfaction – Increased quality of care/outcomes

• Factors rated as neither significant or insignificant

– Revenue from MTM services – Increased patient traffic – Increase in prescription volume/sales

Consistent with 2008 data

MTM Service Barriers: Providers

Among Current MTM Providers (n=432) Among Non-providers (n=168) Significant

• Billing is difficult (3.5)
• Pharmacists have inadequate time (4.0)
• Staffing levels insufficient (4.0)
• Billing is difficult (4.0)
• Dispensing activities are too heavy (3.9)
• Documentation for services is difficult (3.7)
• Payment for MTM services is too low (3.5)

Neither significant nor insignificant

• Pharmacists have inadequate time (3.4)
• Dispensing activities are too heavy (3.3)
• Staffing levels insufficient (3.3)
• Documentation for services is difficult

(3.2)

• Payment for MTM services is too low (3.2)
• Patients not interested or decline to

participate (3.1)………

• Technology barriers (3.4)
• Inadequate training/experience (3.3)
• Inadequate space available (3.2)
• Too difficult to determine patient eligibility

(3.2)

• Too few MTM patients to justify the start-up

cost (3.2)

• Too few MTM patients to justify cost to

maintain the service (3.1)…….

Insignificant

• Management does not support provision
• f services (2.1)
• Eligible patients do not really need it (2.4)

Based on a 5-point rating scale where 5=very significant, 4=significant, 3=neither, 2=insignificant, 1=very insignificant.

Payers- Use of Providers and Methods of Delivery

• MTM Services most often provided by

– Pharmacists in-house (60%) – Contracted pharmacists (40%) – Contracted MTM provider organization (27%)

• Primary Mode of MTM Service Delivery

– Phone (74%) – Face to face (46%) – Multiple methods (18%)

Similar to 2008 Similar to 2008

Payers-MTM Service Value

Significance of MTM Value 5=Very significant, 0= Very Insignificant

Payers-Outcomes Used to Assess Impact of MTM

(n=42)

• Medication Related Costs/Total Costs

– Medication costs overall (62%) – Use of generics (60%) – Overall health care costs (36%)

• Safety Issues

– Drug interactions resolved (67%) – Medication over/under utilization (45%) – Number of high risk medications (45%)

• Patient Focused

– Member Satisfaction (67%) – Improved Compliance/Adherence (48%)

• Quality of Care Issues

– Treatment changed to align with guidelines (36%) – Quality Measure Scores (HEDIS) (33%)

Payers-Impact of MTM

• Inappropriate Medication Use in the Elderly (32%)
• Pharmacy Quality Alliance (PQA) (20%)

– 2009 is the first year this was measured

• HEDIS (14%)
• Patient Quality of Life/Satisfaction Surveys (11%)
• Among 4 payer respondents:

– Median ROI was 3:1 – Median ROI in 2008 was 3.5:1 – Median ROI in 2007 was 3.1:1

Improvements in Quality Measures Reported: ROI:

MTM Service Barriers - Payers

Among Current MTM Payers (n=47) Among Payers Not Offering Services (n=6) Significant

• Patients are not interested or

decline to participate (3.5)

• Patients are not interested or decline

to participate (4.0)

• Too few MTM patients to justify the

cost (3.6) Neither significant nor insignificant

• Skeptical that these types of services

would produce tangible outcomes (3.0)

• Providers do not have the

training/experience (3.0)

• Insufficient MTM providers in the market

area to meet needs (2.7)

• Local physician resistance expressed

(2.7)

• Too few MTM patients to justify the cost

(2.5)

• Insufficient MTM providers in the market

area to meet needs (3.0)

• Skeptical that these types of services

would produce tangible outcomes (2.8)

• Too difficult to determine patient eligibility

(2.7)

• Local physician resistance expressed (2.6)

Insignificant

• Eligible patients do not really need it (2.3)
• Too difficult to determine patient

eligibility (2.0)

• Providers do not have the

training/experience (2.0)

Very Insignificant

(No items ranked in this category)

• Eligible patients do not really need it (1.4)

Based on a 5-point rating scale where 5=very significant, 4=significant, 3=neither, 2=insignificant, 1=very insignificant.

CMS 2010 Part D MTM Requirements

• Opt-out enrollment method only
• New targeting criteria

– No more than 8 chronic Part D medications (2-8) as a minimum number for eligibility – No more than 3 chronic diseases as minimum number for eligibility and must target 4 of 7 core chronic disease states (diabetes, heart failure, HTN, dyslipidemia, respiratory disease, bone disease – arthritis, mental health) – Minimum cost threshold is $3,000 (vs $4,000 in 2009)

CMS 2010 Part D MTM Requirements

• Service requirements

– Annual comprehensive person-to-person comprehensive medication review (CMR)

• Must provide individualized written overview such

as a personal medication record, an action plan, or a reconciled medication list

– Quarterly targeted reviews

• Does not have to be person-to-person

– Interventions with prescribers

• New plan reporting requirements

Patient Care in Health Care Reform

• Coordination of care including care transitions
• Integrated care models

– Accountable Care Organizations (ACOs)

• MedPAC: Set of providers associated with a

defined population of patients, accountable for the quality and cost of care delivered to that patient

– Medical Home Models

• Team-based approach to comprehensive primary

care coordinated by a personal physician

• Receives performance-based incentives for

achieving measurable health improvements www.pcpcc.net

MTM Opportunities in the Healthcare Reform Legislation

• Center for Medicare and Medicaid Innovation

(CMMI)

• Medication Management Services in the Treatment
• f Chronic Disease - MTM Grant Program**
• Community-based Care Transitions Program
• MTM in Health Reform – Part D
• Community Health Teams to Support the Patient-

Centered Medical Home

• Independence at Home Demonstration Program

Pharmacists’ Services in a Reformed Health Care System

• Medication Therapy Management
• Primary Care/Disease State Management
• Wellness and Prevention
• Medication Safety/Safe Distribution

Expanding MTM Services

• Interprofessional team-based approach to

care

– Pharmacist scope of practice

• Coordinated communications
• Impact of health information technology

(HIT)

• Quality measures
• Incentives

Accountable Care Organization

Hospital Specialists Primary Care

Other Possible Components:

Pharmacists Home Health Mental Health Rehab Facilities

What Providers Comprise an ACO? It Varies.

Acknowledgement Brookings Institution

Optimal therapeutic recommendations are based on the experience/needs of the patient

Patient

Comprehensive Medication Management in the PCMH

Clinical Pharmacist/ Pharmacotherapy Manager Physicians/ Providers - PCMH

Patient understands his/her medications and participates in a care plan to improve health Clinical goals of therapy are determined and medication recommendations are considered Gaps in clinical goals are determined, drug therapy problems identified, and therapeutic recommendations made

Appropriate, Effective, Safe and Adherent Medication Use! www.pcpcc.net

APhA-KP Employee MTM Program

• Improve your health – get the most from

your medications

• Experience MTM yourself - better

understand APhA’s work for our members

• Advance APhA’s overall goals of

improving medication use and advancing patient care

Connectivity - HIT Environment

Next Generation Pharmacy Systems

• Meet patient care, distribution &

practice management needs

• Are interoperable with other systems

within the HIT infrastructure

EHR & PHR through HIE Insurers & Other Payers Others

EHR = electronic health record; HIE = health information exchange; HIT = health information technology; PHR = personal health record.

• Official launch in August – 9 pharmacy
• rganizations
• Contracted Director hired – Shelly Spiro
• Collaborative focus:

– Address the profession’s HIT needs & functionality – Influence HIT policy – Ensure technology supports patient care services provided by pharmacists

• Standardize documentation and billing

Performance Measurement: A Growing Reality in Healthcare

Who is currently measured?

Physicians, physician groups, hospitals, nursing homes, home healthcare agencies.

Common elements of performance programs:

• Based on a set of metrics representative of quality

performance in a given discipline

• Financial incentives (or disincentives) based on

measured quality

• Alignment of incentives, care coordination, patient-

centered care 32

Pharmacy Quality Alliance (PQA)

• Established in 2006 as a public-private

partnership by former CMS administrator,

• Dr. Mark McClellan.
• Now operates as an independent, nonprofit

501 C-3 corporation;

• Consensus-based, membership alliance with

50+ members and over 250 active representatives from these company;

• Measures grouped by

category

• Gray arrow indicates
• ptimal

Measure value and number of patients

• Arrow indicates

direction of change from previous period.

• Color indicates if

the change

• ccurred in the

recommended direction.

Value-Driven Health Care

• Cornerstones

– Measuring quality and price (VALUE) of care – Publishing quality and price (VALUE) of care – Effective use of health information technology – Creating positive incentives for high-quality, efficient health care

• P4P models

Source: HHS.gov [homepage on the Internet]. Washington DC: U.S. Department of Health & Human Services; c2008. Available at: www.hhs.gov/valuedriven/index.html . Accessed 2008 Nov 10.

Tools and Resources

MTM Central: www.pharmacist.com/mtm

Questions?

Anne Burns aburns@aphanet.org 202-429-7522