MTM Provides Value for Patients and Payers

Boston—In recent years, medication therapy management (MTM) has become a staple for Medicare Part D. The Patient Protection and Affordable Care Act requires improvements in Part D MTM programs, which are thought to lead to better outcomes in patient care, including improving the quality of care and reducing hospital readmissions.

While the importance of MTM has been accepted almost universally by pharmacists of different expertise, evidence is lacking on the benefits of improved outcomes in patients. Furthermore, there is no clear consensus on how to integrate such programs into health plans successfully.

During a session at the AMCP meeting, speakers discussed several MTM programs, their structure and integration, how their success and outcome improvement were measured, and how to address certain barriers to implementation of MTM programs.

Measuring Value
Stephanie Ross, PharmD, BCACP, primary care clinical pharmacist, Capital District Physicians Health Plan (CDPHP), opened the session by outlining CDPHP’s implementation of their MTM program. CDPHP is a not-for-profit health plan with nearly 450,000 members in 24 counties in New York. Currently, CDPHP has a mixed model MTM program, which includes community pharmacists, managed care pharmacists, and pharmacists within its Enhanced Primary Care patient-centered medical home program.

She said when health plans are looking at MTM opportunities they should address 3 questions:
(1) What tools are available to assess the medication therapy reviews completed by pharmacists?
(2) How does a health plan attempt to support a network of pharmacists to foster consistency for medication reviews?
(3) How do you measure the value/outcomes of MTM services?

In assessing the MTM service provided, Dr. Ross noted that a need exists for health plans to understand the type of MTM service being provided beyond the Centers for Medicare & Medicaid Services; however, there is no published or publically available tool to assess pharmacist-provided MTM service. Therefore, implementing periodic reviews of a sample of completed MTM cases will yield valuable information.

CDPHP evaluated comprehensive medication reviews (CMRs) completed in 2013. They focused on high-volume sites and randomly selected cases for each pharmacist. The assessment tool was shared with contracted pharmacists and a selection of reviewed cases were discussed with the pharmacist and/or MTM lead pharmacist.

The findings showed an opportunity to establish best practices and the need to support pharmacists to help maximize potential outcomes, according to Dr. Ross. As a result, quarterly reviews of CMR cases performed by CDPHP pharmacists will be implemented and feedback will be provided to the pharmacist.

Support of MTM pharmacists is crucial to the program’s success, she said, highlighting CDPHP’s efforts:
• Training/refresher course given to all currently participating pharmacists
• Detailed training provided to all new pharmacists
• Established MTM best practices for their organization
• Disease state training/continuing education events offered quarterly

To measure the value and outcomes of MTM, the organization examined the annual hospital admission rate for members eligible for the 2012 program and compared it to the rest of CDPHP’s Medicare beneficiary population.
The study cohort included 22,697 Medicare members continuously enrolled with prescription coverage from January 1, 2011, through December 31, 2013.
Members eligible for MTM (n=5193) resulted in a 3% reduction in hospital admissions from 2012 to 2013, while Medicare beneficiaries who did not receive MTM (n=17,504) had a 1.3% increase in admissions. Furthermore, CDPHP estimated 225 admissions were avoided in 2013 by members who were eligible for MTM services in 2012, resulting in estimated cost savings of $2.6 million, said Dr. Ross. “The value of MTM is far reaching,” she said. “Follow trends, set new benchmarks, and be creative.”

Return on Investment (ROI)
Because MTM means increased work of pharmacists and necessary investment on behalf of plans, many payers want to know the ROI. Paul Brock, RPh, manager, clinical pharmacy care center, Group Health Cooperative, shared study outcomes of Group Health’s ROI for post-hospital medication reconciliation by pharmacists. Group Health, a nonprofit integrated group practice and health plan in Washington, has 25 group health primary care centers, approximately 600,000 members, >900 physicians, and 200 pharmacists.

The retrospective, quality improvement study assessed the impact of ambulatory pharmacist medication reconciliation for post-discharge patients. The study included 556 patients discharged from Group Health contracted hospitals identified as high-risk for readmission. Of the 556 patients, 281 received medication reconciliation by a clinical pharmacist 3 to 7 days post-discharge and 275 patients did not receive this intervention.

The results showed a statistically significant decrease in readmission rates 14 days post-discharge in the intervention group compared with the control group (4% vs 8%, respectively). Medication reconciliation also identified a high rate of medication discrepancies; 80% of patients had at least 1 medication discrepancy and 31% of drug–drug interactions were contraindicated, which were resolved prior to follow-up physician visits.
The ROI was significant. Group Health estimated that the prevention of 1 hospital readmission saved $15,000. When Group Health looked at ROI for the 3000 medication reconciliations performed by pharmacists in 2013, their ROI formula came up with a $552 cost saved per patient resulting in a net savings of $1.65 million, according to Mr. Brock.

“Pharmacy as a profession is at a crossroad,” he said. “We must prove our value as never before and determine ways to be compensated for it.” In closing, Mr. Brock outlined strategies to optimize MTM value (Table).
Alan Pannier, PharmD, MBA, pharmacy services manager, VRx Pharmacy Services, Veridicus Health, also offered insight on MTM and its value. In addition to being a full-service pharmacy benefits manager, Utah-based Veridicus Health, offers a MTM program. Clinical pharmacists provide telephonic MTM services to patients nationwide.

MTM services should be comprehensive in nature, addressing the whole patient, he advised. Value should be demonstrated in collaboration with the plan sponsor and focused on tangible benefits. Continued innovation and adaption of MTM models will lead to further benefits outside of traditional services.

“Managed care organizations are in the prime position to provide MTM services,” concluded Dr. Pannier.—Eileen Koutnik-Fotopoulos