As our society seeks to provide more effective and efficient health care, it is becoming increasingly more important for pharmacists to recognize the importance of implementing patient-care services and supporting their integration into the health care system. The number and variety of patient-centered services offered by pharmacies has increased in the last several years, primarily due to the rising attention garnered by medication therapy management (MTM). Jane Allen, PharmD, MBA who currently serves as the MTM Pharmacist for Hy-Vee, presented the following information about the MTM opportunity to the Drake DELTA Rx student branch on October 24, 2012.
What is MTM?
Medication therapy management includes all patient-centered services focused on improving medication therapy. These services optimize care through interventions and referrals aimed at preventing drug therapy problems. Recent statistics have shown an incidence of 1.5 million preventable adverse drug reactions each year, leading to a $177 billion spent in mortality and morbidity costs. More importantly, these services provide an opportunity for pharmacists to demonstrate their value to the health care process in making patients lives easier, happier, and healthier.
Barriers to MTM
What’s hindering MTM’s rise in popularity? One main deterrent to the implementation of these services is a simple lack of understanding. Many are unaware of the benefits involved in its use, while others may still be hindered by a lack of pharmacist availability or challenges involved with processing reimbursements for these services. In the end, the time required for these services prevents many from seeing their benefits.
What can be done to overcome these barriers? The inclusion of a pharmacist devoted solely to the completion of MTM at pharmacies can allow for the time and effort required to perform the services and process the reimbursements. It is also important to recognize the importance of utilizing MTM management programs, including OutcomesMTM or Mirixa.
Results
MTM services are of great value to patients. Patients are empowered to take control of their health and greatly improve adherence to medications. The potential for revenue is of great value to pharmacies, one that is highly underutilized. In additional, the inclusion of these services is considered for CMS Star ratings. Pharmacies with a five-star rating receive a bonus on reimbursements.
Common services leading to significant reimbursements include:
A CMR, in particular, has been shown to lead to a 90% retention rate in patients. The appointment is centered around the patient and is used to address how each of their medications is working, evaluate past medical history to determine if the therapy is appropriate, and identify and provide any necessary immunizations. An average appointment runs about 40 minutes, with an additional 30 needed for billing, yet can yield an initial flat fee of $50-75, depending on the patient’s Medicare Part D plan. Additionally, each medication problem addressed yields an extra $20, including any physician contact and administration or technique education. On average, a CMR will include 4 medication problems, which, with the initial fee, yield a minimum of $130 per CMR.
While the potential for revenues from these services is good, offering MTM services requires time that may not be feasible in an average pharmacy setting. The addition of an MTM specialized pharmacist may be the solution. The creation of the role at Hy-Vee increased total claim submissions from 46 in a 6-month period to 724, a 1473.9% increase. The number of CMRs completed in that time period increased from 3 to 130, a 4166.7% increase, leading to an estimated cost avoidance of $498,534.04.
The national average of patients served in top rank chain pharmacies with MTM services is 29%. Since the addition of an MTM pharmacist, Hy-Vee has increased to 40.6% of patients served in the Des Moines area, above even the top chain pharmacies in the category.
Since it’s emergence, MTM has grown into a vital part of community pharmacy services. However, many pharmacists and patients are unaware of the opportunities that these medication related patient services offer. Pharmacists need to be informed of the opportunities available to encourage its inclusion into the workflow. Patients, as well, need to be educated on the services available to them and the potential benefits of these indispensable services.
For more information, contact Jane Allen, Hy-Vee Medication Therapy Management Pharmacist, at jkallen@hy-vee.com.
