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white paper 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] - Page 2 - 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] - Page 3 - 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. - Page 4 - “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. 6200 Tennyson Parkway Suite 200 Plano, Texas 75024 214.618.9880 www.ZeOmega.com [email protected] Copyright 2015 ZeOmega, Inc. All rights reserved. ZeOmega and Jiva are registered trademarks or trademarks of ZeOmega, Inc. or its subsidiaries in the United States and other countries. Other mark or brands may be claimed as the property of others. - Page 5 - WP-MTM-040815