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The Value of Integrating Medication
Therapy into the Care Management Process
By Rachel Koh, RPh, MBA
Director of Clinical Product Strategy, ZeOmega
As healthcare continues its rapid evolution from pay-forperformance to more patient-centric care management
and delivery models, medication therapy management
(MTM) is becoming increasingly important for healthcare
organizations seeking to lower costs, improve outcomes,
engage patients, and comply with changing regulatory
requirements. Traditional MTM approaches are no longer
optimal. Organizations will need to integrate MTM into care
management workflows to ensure continued success.
Introduction
The medications American’s consume each year account for a significant amount of overall healthcare
spending. A look at the numbers is quite eye opening. According to the Centers for Disease Control:
THESE AILMENTS ARE
MOST COMMONLY
TREATED WITH
MEDICATION, OFTEN
MORE THAN ONE
DRUG PER PATIENT.
http://scriptyourfuture.org/wp-content/themes/cons/m/release.pdf ; Osterberg 2005, NEJM; Ho 2009, Circulation
CDC Education Module (Released March 27, 2013)
[3]
http://www.cdc.gov/medicationsafety/CDC Education Module (Released March 27, 2013)
[4]
Avoidable Costs in US Healthcare”, IMS Institute for Healthcare Informatics”, June 2013
[1]
[2]
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IN GENERAL, MEDICATION
ISSUES COST THE U.S.
HEALTHCARE SYSTEM
ABOUT $200 BILLION
A YEAR IN AVOIDABLE
EXPENSES[4], ABOUT HALF
OF WHICH CAN
BE ATTRIBUTED TO
NON-ADHERENCE.
What is Medication Therapy
Management (MTM)?
Clearly, medication-related issues have become one of the costliest outliers in a healthcare system already
fraught with inefficiencies and escalating expenditures. The increasing reliance on MTM — ensuring that
medication therapy is administered, managed, and monitored for maximum effectiveness — is therefore
as timely as it is necessary.
As defined, MTM is a service or group of services that optimize therapeutic outcomes for individual patients.
This includes:
• Medication therapy reviews
• Pharmacotherapy consult
• Immunization
• Health, wellness, and public health
• Disease management coach and support
• Medication safety surveillance
• Pharmacogenomic applications
• Anticoagulation management
“The benefits MTM can bring to individuals and the
healthcare system at large are so potentially impactful
that the Centers for Medicare and Medicaid Services
(CMS) has mandated Medicare Advantage plans offering
Part D benefits to provide MTM services to optimize
therapeutic outcomes and medication safety.”
By design, MTM aims to help patients realize the most benefits from their medications by actively managing
drug therapy and by identifying, preventing, and resolving medication-related problems. According to the
American Pharmacists Association and National Association of Chain Drug Stores Foundation, an MTM
program in pharmacy practice should include these core elements[6]:
Medication therapy review: A systematic process of collecting patient-specific information, assessing medication
therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and
creating a plan to resolve them.
Personal medication record: A comprehensive record of the patient’s medications (prescription and nonprescription,
herbal products, and other dietary supplements).
Medication-related action plan: A patient-centric document containing a list of actions for the patient to use in tracking
progress for self-management.
Intervention and/or referral: The provision of consultative services and interventions to address medication-related
problems. When necessary, the pharmacist refers the patient to a physician or other healthcare professional.
Documentation and follow-up: Consistent documentation of MTM services and scheduling of follow- up MTM visits
based on the patient’s medication-related needs, or when the patient is transitioned from one care setting to another.
http://www.pharmacist.com/mtm
American Pharmacists Association and National Association of Chain Drug Stores Foundation. Medication Therapy Management
in Pharmacy Practice: Core Elements of an MTM Service Model Version 2.0. 2008.
[5]
[6]
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Why We Need MTM
The benefits MTM can bring to individuals and the healthcare system at large are so potentially impactful that the
Centers for Medicare and Medicaid Services (CMS) has mandated Medicare Advantage plans offering Part D benefits
to provide MTM services to optimize therapeutic outcomes and medication safety. CMS is placing such importance on
MTM that it has included five medication issue-related measures in its comprehensive Star ratings measures — each of
which carries three times the weight of the other process measures:
• High Risk Medications
“An optimally effective MTM program,
therefore, is one that integrates with other
care and population health management
processes to provide each stakeholder
with a comprehensive, 360-degree view of
a patient’s healthcare profile.”
• Diabetes Treatment
• Medication Adherence for Diabetic Medications
• Medication Adherence for Hypertensive Medications
(RAS Antagonist)
• Medication Adherence for Cholesterol (statins)
The Integrated Approach
While MTM is hardly a new concept, its increasing
importance in modern healthcare is causing the industry
to re-examine and re-think the methodologies for
administering it.
Traditionally, MTM has existed in its own silo, separate
from other care management processes. Consequently, a
pharmacist overseeing MTM will know what prescriptions
a patient is taking, but more than likely be unaware of the
other details in their overall healthcare profile. Conversely,
a physician treating the same individual will certainly be
familiar with the medications he or she has prescribed, but
have no knowledge of those prescribed by other providers.
Clearly, this creates a potentially dangerous and costly
gap. An optimally effective MTM program, therefore, is
one that integrates with other care and population health
management processes to provide each stakeholder with a
comprehensive, 360-degree view of a patient’s healthcare
profile. Today’s information technology can (and should)
have the ability to analyze more complete and robust
patient data for appropriate drug therapy adherence,
missed treatment programs, and/or risk of medicationrelated adverse events. This approach is also vital for
managing patients with more than one chronic condition.
“Integrating medication therapy management into the
overall care management process helps healthcare
organizations achieve the Triple Aim goals of lowered costs,
improved patient care, and better overall outcomes.”
Also, as population health management continues to
trend more toward the coordination of care among various
stakeholders, an integrated medication management
approach is an ideal way to ensure pharmacists’ rightful
place in the continuum. It can help bring them out of their
existing siloes and into the proverbial loop where they can
play an integral role in overall care coordination before
other care team members take on the role with automation.
An additional — but no less important — benefit of
integrated medication management is that it helps
healthcare organizations achieve the Triple Aim goals of
lowered costs, improved patient care, and better overall
outcomes.
In addition to frequently being prescribed more than one
medication, these individuals often require multidisciplinary
interventions such as case or disease management. An
integrated solution can streamline these various referrals
and serve as a central repository of all relevant patient
clinical information.
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“Integration is essential. It allows clinicians to identify
medication issues and engage pharmacists for proper
interventions.”
What to Look For
In terms of specific features and functionality, there are
a number of key components an integrated medication
management solution should provide to help healthcare
organizations meet immediate requirements and changing
needs as they evolve over time.
CMS-compliant workflow, correspondence, and reporting,
along with patient identification algorithms and clinical rules
packages that provide an advanced level of medication
issue recognition are key. While it is essential to have
resources that can identify drug-drug interactions, those
that go to the next level — drug-age and drug allergy
interactions — are preferable. Bundled rule packages
for drug interactions and medication reconciliation to
identify duplicate therapy and dosing concerns are even
more powerful. Organizations will also need clinical rules
packages to recognize medication issues using evidence
based guidelines.
Of course, integration is essential. It allows clinicians to
identify medication issues and engage pharmacists for
proper interventions. This means pharmacists can devote
their valuable resources to addressing medication-related
problems, while nurses can identify them without overrelying on pharmacists. Ideally, a solution should offer the
flexibility to accommodate certain standalone scenarios
as well — those instances in which pharmacists/pharmacy
vendors wish to increase the value of their cognitive
services with an automated solution using evidence based
guidelines. This can streamline workflow and decrease
the administrative cost of offering MTM services by better
focusing pharmacy resources to impact clinical outcomes.
“Only by integrating medication therapy with
care management workflows can organizations
ensure that the patient is at the center of the care
spectrum — which is a primary goal of evolving
methodologies and guidelines.”
Conclusion
Integrated medication management is poised to play
an increasingly significant role in care management as
healthcare organizations seek to conform to new delivery
models and comply with more stringent regulatory
mandates. Traditional MTM approaches, while effective,
are no longer optimal since they exist in silos apart from
other processes. Only by integrating MTM with care
management workflows can organizations ensure that the
patient is at the center of the care spectrum — which is a
primary goal of evolving methodologies and guidelines.
Including integrated medication management in the
creation of more complete and thorough patient profiles
means all stakeholders can work together to devise better,
individualized health plans that improve care, lower costs,
and empower patients.
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214.618.9880
www.ZeOmega.com
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