Stepping out from behind the drug counter to have a hand in direct patient care presents a huge opportunity for pharmacists who can improve patient care and their own business health by offering medication therapy management, or MTM, services to their customers.
Accountable care organizations, medical homes, bundled payments and other coordinated-care financing and delivery models all demand lower costs and better outcomes to be successful. That’s where pharmacists and MTM services come in. Who better to help patients make the most of their medication regimens and help payers and providers hit their cost and quality targets?
Medication misuse is responsible for upwards of $200 billion in unnecessary use of healthcare resources each year, reports the IMS Institute for Healthcare Informatics in Parsippany, N.J. In Medicare Part D, poor medication adherence results in “significantly higher” Medicare Part A and Part B costs, ranging from $49 to $840 per member per month, according to a study in the July issue of Health Affairs. These findings highlight the need for MTM and the chance for pharmacists to build a business around improving patient care.
“There are lots of opportunities out there, and it’s just a really great time to capitalize on them,” says James Owen, associate vice president of practice and science affairs at the American Pharmacists Association in Washington.
Medication therapy management is the term Congress coined to describe activities designed to optimize therapeutic outcomes and reduce adverse drug events in Medicare Part D. Today, “MTM” is widely used to describe a broader set of medication management services, encompassing everything from medication therapy reviews and pharmacotherapy consultations to immunizations and health and wellness programs.
Pharmacists are providing MTM from a variety of healthcare practice sites and retail settings. For the pharmacist employed by a physician group or health system, it can be an effective strategy for reducing costly readmissions and freeing up doctors to see more patients. Retail pharmacists look to MTM to expand revenue-making opportunities, increase store traffic and segue into direct patient care.
As pharmacists are not recognized as direct providers of care, billing opportunities are limited. And while Medicare Part D covers MTM services, only patients with multiple chronic conditions taking multiple Part D-covered drugs with high annual drug costs—at or above $3,144 in 2013—are eligible.
Fortunately, the payer mix has begun to diversify, with more state Medicaid programs, commercial health plans and employer-sponsored plans adding medication management as a covered service.
For pharmacy executives and owners, the trick is cobbling together enough business opportunities and patient volume to make MTM profitable. The most successful pharmacists tend to be those who achieve critical mass by aligning with multiple payers and providers of care, experts say.
Also critical to MTM success is a pharmacy’s EHR capability. Managing medications requires the ability to access to patients’ electronic health records and share information with their providers of care. In retail stores, pharmacists often have limited patient data on hand. With access to patients’ lab results, medical history, medication history and medication list, they could provide better service.
In 2010, nine pharmacist organizations formed the Pharmacy E-Health Information Technology Collaborative to advocate for electronic health record standards that support pharmacist-provided patient care services across all practice sites and retail settings.
Pharmacy leaders can help advance MTM by ensuring that pharmacists get proper training to provide this level of care.
As coordinator of the MTM program at the Mayo Clinic’s Jacksonville, Fla., campus, Michael Schuh, says he sees a wide range of patients, from transplant recipients on anti-rejection medications to people popping all sorts of herbal supplements. His practice relies on physician referrals to generate patient volume, including some people who are willing to pay out of pocket.
Schuh, who teaches in the MTM master’s program at the University of Florida, says, “There are so many different models of this, and we don’t even really know what all models are possible.”
It’s that wide-open opportunity to create their own MTM that should spur pharmacists to put their white coats to broader use to improve patient care and their own business health.