RxTM Medication Therapy Management Services

Transcription

1 RxTM Medication Therapy Management Services Rx Therapy Management Rx Therapy Management is committed to improving the health of the communities we serve by promoting excellence in pharmacy services, patient-centered care, and collaboration among healthcare providers. Our programs are designed to enhance pharmacy practice across the Commonwealth and improve therapeutic outcomes in all patients while demonstrating the value of the pharmacist as an integral part of the healthcare team. Medication Therapy Management Medication Therapy Management (MTM) may be defined as a set of services designed to improve therapeutic outcomes for patients and assist members with understanding their medication costs, adherence, and overall prescription safety. The primary goals of MTM are to optimize therapeutic outcomes through improved therapeutic use and reduce the risk and occurrence of adverse drug events. MTM occurs independently of dispensing, but may involve the provision of a medication product. MTM service may include a combination of a Comprehensive Medication Review (CMR), Desktop CMR (dcmr), and Targeted Medication Reviews (TMRs). The MTM services may include communications that are face to face, by phone, or by mail between a member and a pharmacist. The pharmacy/pharmacist providing the MTM will be reimbursed for providing cognitive services. Requirements of the Centers for Medicare and Medicaid Services will be followed for all Medicare Part D plans, including no charge to the eligible member. Participating plans will be able to specify eligibility requirements, types of services, and reimbursement.

2 RxTM Provider Network (RxTMPN) RxTM provider network participation is required in order to perform MTM services with RxTM. All pharmacies in the state of Kentucky are eligible to participate. Joining the provider network consists of completing the following documents: Network provider agreement, credentialing application, and software licensing agreement with Clinical Support Services (CSS). The members of the network will be eligible to participate in all MTM programs as well as other clinical services as developed. RxTM services include determining eligibility, initial contact to offer MTM services, managing opt-out program, assigning members to a network pharmacy in Kentucky, reporting CMS required data, and performing MTM services to members and follow-up when necessary. There are no specific training requirements to participate in the Provider Network for MTM services. Basic MTM training programs are suggested to understand the structure of MTM services. Pharmacists are expected to remain up to date on National Disease State Guidelines, current drug therapies, and self-management. Pharmacists are required to participate in all MTM training specified by their pharmacy or corporate chain (if applicable) before performing MTM with RXTM. If there are no set requirements within the pharmacy or corporate chain, continuing education can be recommended by RxTM. Medication Pathfinder and MTMPath Software RxTM will be utilizing the Medication Pathfinder (MTMPath) platform developed by Clinical Support Services (CSS) for documentation and billing of MTM services. This platform was designed to streamline the MTM program within a pharmacy. The software will assist with the management of patient MTM services, billing, and reporting of data to CMS. Training sessions for utilization of this platform and technical support will be made available. All services performed must be documented and billed in the Medication Pathfinder platform before reimbursement can occur. Once a part of the provider network, use of the software is not limited to RxTM MTM. The pharmacist can use all applications of the software for other programs within their pharmacy. The website is referenced below. Medication Pathfinder website: MTMPath MTMPath software has several modules, each customized for RxTM s MTM services:

3 DataPath -Clinical Data Collection and Organization Module -Allows pharmacists to collect clinical information (i.e. labs, progress notes, etc.) from patient charts and organize the profile using the MTMPath Patient Registry. Demographic information and prescription fill or claims data is uploaded to ensure that complete information is ready and waiting for patient MTM reviews. The clinical data collection form can be printed by the pharmacist and sent to the physician once the MTM is scheduled and returned data can be entered prior to the MTM. InterviewPath Patient Assessment Module - This onsite, informationgathering module guides the pharmacists through the process of interviewing and collecting patient data that will augment the clinical/claims data that has been compiled. MTMPath provides structured, easy-to-use patient assessment tools that allow pharmacists to complete patient assessments efficiently, effectively, and consistently. Pharmacists can complete their own patient assessments, using standardized assessments built into the software (geriatric depression, mini-mental state, etc.). InterviewPath reduces pharmacist time required for patient assessment, reduces program costs and improves program ROI. RxCarePath - Recommendation Creation Module(s) RxCarePaths are therapy-specific guides (e.g. diabetes, asthma, etc.) embedded in MTMPath that walk pharmacists quickly through complex drug regimen assessment procedures. Each RxCarePath module identifies the targeted therapy in the profile, provides a series of patient-centered questions for pharmacists to complete, and suggests standardized recommendations. Each RxCarePath assures a high degree of inter-rater reliability among the pharmacists conducting MTM; a standard regime of patient assessment and clinical data collection; and focused reporting with regard to MTM processes and outcome measures. Pharmacists using RxCarePaths can quickly produce high-value recommendations, improving program impact and ROI. ReportPath Physician/Patient Report-Generating Module. This module also allows pharmacists to create patient and provider-specific letters, chart abstract forms, and other documents for purposes of assisting patients to take the next steps toward optimizing their medication regimen. The ReportPath function produces a full MTM report with patient history and individual therapy recommendations -- all at the push of a button -- eliminating the time required for a pharmacist to produce recommendations. Letters can be easily created to inform the patient of the pharmacist s findings, and to support the pharmacist in coordinating patient-approved recommendations that have been approved by the patient. The MTMPath report meets American Society of Consulting

4 Pharmacies and CMS s MTM reporting standards, giving a nationally-recognized benchmark for all MTM services utilizing the program. Work Queue Reminder Module - Allows the pharmacist to designate an appropriate follow-up date for tracking patients and their associated recommendations. On the date a patient is designated for review, he or she appears in the pharmacist s Work Queue. Recommendations remain in the Work Queue until they are addressed by the pharmacists, so that no patient is lost to follow-up. By reviewing the Work Queue, pharmacists are notified of the need to assess, re-assess, or follow-up with the care of a patient. BillingPath Patient and Insurance Billing Module Once a CMR, dcmr, or TMR is complete, this module also gives RxTM the ability to act as a third-party administrator for clients, collecting pharmacists bills for MTM services; aggregating bills for the payer client; reimbursing pharmacists for MTM activity; and providing summary reporting to the client.. PMRSmart - Personal Medical Record-on-Demand Program - Allows patients to access their personal medical record from any computer with an internet connection, including medical offices, pharmacies, emergency rooms, hospitals and patient homes. The PMRSmart record includes the clinical, pharmaceutical and physician assessment information gathered during the pharmacist s MTM review. In addition, patients can use the PMRSmart website to track homebased vitals (i.e. blood pressure, blood glucose and weight). All vitals entered by the patient are included in the patient record, but easily distinguished from those entered by a health care professional. It is fully secure and compliant with HIPAA (Health Insurance Portability and Accountability Act) regulations. This functionality will be available in RxTM s MTMPath software license, but will not be actively marketed to members by RxTM. The pharmacist may provide this information to appropriate MTM patients once they have been provided an MTM service. PMRSmart website: Comprehensive Medication Review (CMR) This poly-pharmacy module streamlines the pharmacist s review of lengthy drug regimens by allowing him or her to view a member s drug regimen and quickly determine that, among other things, there is a diagnosis associated with each drug; and that the appropriate labs, diagnostic tests, vitals and patient assessments have been obtained for appropriate monitoring. In addition, the CMR assessment tool identifies potential drug interactions (Severity Level 1 and 2), Beer s List concerns, medication efficiency items and formulary alerts. Finally, the CMR assessment streamlines the creation of recommendations by allowing

5 pharmacists to quickly generate a recommendation while viewing the potential medication issue. The dcmr and TMR modules are shortened versions of the CMR. MTM Services Available Comprehensive Medication Review (CMR) A CMR is a review of the patient s medications, including prescription, nonprescription and supplements, which is intended to assess medication therapy and optimize patient outcomes. Reviewing medications and identifying medication related problems can occur before the patient encounter, but a CMR is most effective when supplemented by an interactive consultation with the member. This interaction may be face to face or over the phone and allows for a complete assessment of the patient s needs to improve medication use or outcomes. The consultation will provide more information on health status, clinical information, adverse events, and other concerns which will aid the pharmacist in the assessment process. The final step in the CMR is to provide a summary of the gathered information and recommendations for the patient. This will include a personal medication record, action plan, and any recommendations for monitoring, education, or self management. Desktop Comprehensive Medication Review (dcmr) If a patient declines the full interactive portion of the CMR or cannot be reached by the pharmacy, but does not opt out of the MTM program, the medication review will still occur and the prescriber will be offered interventions that are beneficial or of concern for the patient. The patient will then receive by mail a personal medication record, action plan, and any recommendations for monitoring, education, or self management. Targeted Medication Review (TMR) A TMR may take on many forms, but includes a review of the patient s current medication therapy and a needs assessment since the CMR or dcmr. The interaction may be face to face, over the phone, or by mail. The assessment will include medication use, new or discontinued medications, and any unresolved issues or recommendations from the original assessment. The TMR may include focus on a particular formulary drug, provision of a medication product, or education. The patient will receive an updated personal medication record, action plan, and any new recommendations for monitoring, education, or self management either in person or by mail.