Insights into Pharmacist Provided MTM Services-Present and Future

Transcription

1 Insights into Pharmacist Provided MTM Services-Present and Future Anne Burns, RPh Vice President, Professional Affairs American Pharmacists Association

2 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.

3 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:

4 MTM in Pharmacy Practice Medicare Part D MTM

5 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 or managed care/health plans

6 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

7 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

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

9 APhA MTM Digest Highlights of pharmacist provider and payer surveys on MTM services MTM Definition for survey = pharmacy profession consensus definition MTM provided faceto-face and by phone New trending graphs comparing survey data from 2007 and 2008

10 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

11 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

12 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

13 Value to Providers from MTM Services Factors rated as significant to providers Improved professional satisfaction Improved patient satisfaction Consistent with 2008 data Increased quality of care/outcomes Factors rated as neither significant or insignificant Revenue from MTM services Increased patient traffic Increase in prescription volume/sales

14 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 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) Management does not support provision of services (2.1) 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). 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.

15 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

16 Payers-MTM Service Value 5=Very significant, 0= Very Insignificant Significance of MTM Value

17 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%)

18 Payers-Impact of MTM Improvements in Quality Measures Reported: 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%) ROI: 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

19 MTM Service Barriers - Payers Among Current MTM Payers (n=47) Among Payers Not Offering Services (n=6) Significant Neither significant nor insignificant Patients are not interested or decline to participate (3.5) 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) Patients are not interested or decline to participate (4.0) Too few MTM patients to justify the cost (3.6) 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.

20 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)

21 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

22 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

23 MTM Opportunities in the Healthcare Reform Legislation Center for Medicare and Medicaid Innovation (CMMI) Medication Management Services in the Treatment of 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

24 Pharmacists Services in a Reformed Health Care System Medication Therapy Management Primary Care/Disease State Management Wellness and Prevention Medication Safety/Safe Distribution

25 Expanding MTM Services Interprofessional team-based approach to care Pharmacist scope of practice Coordinated communications Impact of health information technology (HIT) Quality measures Incentives

26 What Providers Comprise an ACO? It Varies. Accountable Care Organization Primary Care Hospital Specialists Other Possible Components: Pharmacists Home Health Mental Health Rehab Facilities Acknowledgement Brookings Institution

27 Comprehensive Medication Management in the PCMH Clinical Pharmacist/ Gaps in clinical goals are determined, drug therapy problems identified, and therapeutic recommendations made Pharmacotherapy Manager Optimal therapeutic recommendations are based on the experience/needs of the patient Patient Appropriate, Effective, Safe and Adherent Medication Use! 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

28

29 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

30 Connectivity - HIT Environment EHR & PHR through HIE Next Generation Pharmacy Systems - Meet patient care, distribution & practice management needs -Are interoperable with other systems within the HIT infrastructure Others Insurers & Other Payers EHR = electronic health record; HIE = health information exchange; HIT = health information technology; PHR = personal health record.

31 Official launch in August 9 pharmacy organizations 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

32 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, patientcentered care 32

33 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;

34 Measures grouped by category Gray arrow indicates optimal Measure value and number of patients Arrow indicates direction of change from previous period. Color indicates if the change occurred in the recommended direction.

35 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: Accessed 2008 Nov 10.

36

37 Tools and Resources MTM Central:

38 Questions? Anne Burns