Workshop discussed 'hidden value' of medication therapy management

Jeff Rowe, Contributing Editor

On Wednesday, at the AHIP Institute 2012 in Salt Lake City, Rick Solano, president and CEO of Mirixa, moderated a workshop entitled "Medication Therapy Management: The Next Phase in Managing Chronic Disease."  The session delved into many aspects of MTM and Solano recently took a few moments to discuss MTM and its role in improving the care of people with chronic illness.

Q: The agenda’s introduction to the workshop claims “Initially, MTM was viewed as a means to “check the box” with CMS and comply with regulations.”  How has that played out?

Solano: The mandate for MTM services for Medicare Part D members was part of the Medicare Modernization Act of 2003 and put into effect in 2006. In the first couple of years, health plans were given plenty of latitude in how they delivered the service, with most choosing to send letters to patients. Even in the early days, however, some plans were testing other methods of delivering MTM, including call centers or an in-person consultation with a pharmacist.

(Subsequent) studies revealed that benefits such as resolving safety issues and the implementation of cost saving changes in therapy were significantly greater when the service was delivered “live”.  In short, person to person contact, especially when an existing patient to provider relations exists, improved outcomes. Since then, more and more health plans are providing pharmacist-based MTM services, not only as part of their Medicare Part D programs, but in their commercial populations as well. 

Q: What new approaches are being implemented to make MTM more effective? Are these approaches of benefit to patients, providers and payers alike?

Solano: Technology has of course improved, but the real change that is happening is not in how the service is delivered, but rather in the additional valuable services, which have grown out of MTM – all pivoting on the pharmacist’s involvement. Examples of additional services are adherence programs, formulary alignment, gaps in care programs, new member welcome programs, chronic condition management and health plan star ratings programs. Every one of these additional services is focused on either improving quality or reducing overall healthcare costs. And yes, with MTM, everyone wins: patients, providers, health plans.

Q: Can you give a brief example of a situation that demonstrates the benefits?

Solano: Medication adherence, especially with chronic conditions like diabetes, is a major component of MTM. When a pharmacist is able to work with a patient to get that patient to adhere to their medication regimen, the patient realizes (an) improved quality of life. If the chronic condition is being treated consistently, the patient is also more likely to avoid expensive hospital visits, and the health plan avoids having to cover the additional expense of complications. Additionally, the MTM session often identifies ways for the physician to substitute an inexpensive medication, thereby saving money for both the patient and the health plan. And if that patient was non-adherent due to medication costs, the lower cost drug could help achieve adherence.

Q: How do you see changes in MTM playing out over the next five years?

Solano: I see CMS continuing to widen the criteria for qualifying patients for MTM services, thereby expanding the number of Medicare beneficiaries who receive this crucial service. We are also seeing a strong uptake on the part of health plans to replicate the improved outcomes and return on investment of providing MTM services to chronically ill patients in non-Medicare populations.

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