Pharmacists Improving Care and Reducing Costs for … · Pharmacists Improving Care and Reducing...
Transcript of Pharmacists Improving Care and Reducing Costs for … · Pharmacists Improving Care and Reducing...
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Pharmacists Improving Care and Reducing Costs
for Your Plan Participants
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[Insert Name of the MTM Practice (Pharmacy or Pharmacist)]
• Who are we?
• Where are we located?
• Who are our pharmacists?
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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.
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Medication-Related
Problems
$$$$Increased Costs to the
Health Care System
$$$$Increased Costs to
Employers
$$$$Increased Insurance Premiums or Direct
Costs
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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.
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Who Needs Medication Therapy Management?
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Where Are You Spending YourHealth Care Dollars?
Kaiser Family Foundation, 2007. http://www.kff.org/insurance/index.cfm
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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
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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
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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
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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
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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)
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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
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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
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A Case Example From Our Practice
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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
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MTM Services In Action
• Minnesota Medication Therapy Management Care Program
• The Asheville Project
• [Insert Examples from your practice]
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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
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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
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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
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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]
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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
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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.
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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]
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• 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
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• 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
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• 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.
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• 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.
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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.
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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.
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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
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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
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[Insert Name of the MTM Practice (Pharmacy or Pharmacist)]
• [insert content]
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Billing, Compensation, and Reporting
• [insert content]
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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
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Contact Information
• [insert contact information]
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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
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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
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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
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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.
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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