Pharmacists Improving Care and Reducing Costs

for Your Plan Participants

[Insert Name of the MTM Practice (Pharmacy or Pharmacist)]

• Who are we?

• Where are we located?

• Who are our pharmacists?

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.

Medication-Related

Problems

$$$$Increased Costs to the

Health Care System

$$$$Increased Costs to

Employers

$$$$Increased Insurance Premiums or Direct

Costs

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.

Who Needs Medication Therapy Management?

Where Are You Spending YourHealth Care Dollars?

Kaiser Family Foundation, 2007. http://www.kff.org/insurance/index.cfm

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– Immunizations– Wellness screenings – Smoking cessation – Weight management

MTM Core ElementsService Model

• Developed by the American Pharmacists Association and the National Association of Chain Drug Stores Foundation

• Supported by 10 national pharmacy organizations

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

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

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)

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

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

A Case Example From Our Practice

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

MTM Services In Action

• Minnesota Medication Therapy Management Care Program

• The Asheville Project

• [Insert Examples from your practice]

Clinical Outcomes of MTMMinnesota 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 A1C value was 7.38% (range 4.9%-14.7%, std

dev. =1.82%) – 77% (88/114) of recipients with diabetes achieved hemoglobin A1C

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

Clinical Outcomes of MTMThe Asheville Project - Asthma

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.

Improved Asthma control sustained over 5 years

Clinical Outcomes of MTMThe Asheville Project - Diabetes

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.

A1C < 7%Total Cholesterol < 200 mg/dl

LDL < 100 mg/dl

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]

Economic Outcomes of MTMMinnesota Medicaid MTM Care

Program

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

Decrease in:•Prescriber & non-prescriber provider costs•Ambulatory care costs•Lab & Diagnostic costs •Other costs

Average Annual Costs to Employer for Participants

$0$2,000$4,000$6,000$8,000

$10,000$12,000$14,000

Pharmacist $0 $414 $268 $240 Medication $1,667 $3,045 $3,748 $3,093 Medical $7,368 $5,454 $4,786 $4,157

Baseline 2002 Year 1 Actual Year 2 Actual Year 3 Actual

Total costs $9,035 $8,913 $8,802 $7,490

(N = 63)

Year 3 SavingsPer Patientfrom Projected Costs$6,250from Baseline Costs$1,545

Yr 1 Projected$10,390

Year 3 Projected$13,740

*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.

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.

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]

• American Pharmacists Association survey of pharmacist providers and payers – MTM implementation

strategies– Value of MTM services

• www.pharmacist.com/MTM

APhA MTM DigestExamining the Value of MTM Services

• 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

• 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.

• 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)

Schommer JC, et al. Pharmacist-provided medication therapy management (part 2): Payer perspectives in 2007. J Am Pharm Assoc. 2008;48:478–86.

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.

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.

Considerations for Providing MTM Services to Your Plan Participants

• 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

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

[Insert Name of the MTM Practice (Pharmacy or Pharmacist)]

• [insert content]

Billing, Compensation, and Reporting

• [insert content]

Together we can…Reduce the risk to your plan participants caused by medication-related problemsImprove care and outcomes for your plan participantsHelp you reduce the health care costs for your plan Optimize medication use and improve your plan participants’ quality of life

Contact Information

• [insert contact information]

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

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

Clinical Outcomes of MTMAsthma Patients

Baseline 5-yr follow-up

Asthma Action Plans

63% 99%

Emergency Department Visits

9.9% 1.3%

Hospitalizations 4.0% 1.9%

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

Economic Outcomes of MTM

Average cost change to patient

$426 savings($116 – $1,060)

Total cost change for all patients

$2,980 savings

Decrease in yearly Rx cost to health plan (N = 7 patients)

Rx cost to patient/year (N = 7 patients)

Average cost change to payer per patient

$189 savings ($352 extra cost –

$816 savings)Total cost change for payer for all patients

$1,320 savings

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.

Billing, Compensation, and Reporting

• Billing – Bulk billing for all patients at the end of every month

• Reporting – Population data provided every 6 months

• Compensation Type of Service $/hrComprehensive Medication Review

Targeted Medication Review – Diabetes

Targeted Medication Review – Asthma