CMS report affirms pharmacist-provided MTM

Abstract

If CMS invests money in medication therapy management (MTM) programs for Medicare patients, do these programs improve the quality of chronic care management and reduce health care expenditures? That was the ultimate question behind the major new Medication Therapy Management in Chronically 1ll Populations: Final Report prepared for the CMS Center for Medicare & Medicaid Innovation, according to an APhA Fellow’s analysis of the August 2013 report. The APhA Fellow is Maj. Ann D. McManis, BSPharm, MPA, U.S. Air Force, Biomedical Sciences Corps. ■A major CMS report shows MTM improves adherence, quality of prescribing.■MTM programs that maintained or lowered drug costs were in integrated health systems that used an electronic health record. ■A major CMS report shows MTM improves adherence, quality of prescribing.■MTM programs that maintained or lowered drug costs were in integrated health systems that used an electronic health record. The 242-page report is available at http://innovation.cms.gov/Files/re-ports/MTM_Final_Report.pdf. The report suggests both that “there’s a huge untapped source of improving our health care system that’s not being taken advantage of” because Part D MTM should be available to more people than the current very narrow criteria allow, and that “when there’s coordination of care between the community pharmacist and a physician and a patient, that’s what really helps make the intervention successful,” said APhA President-elect Matthew C. Osterhaus, BSPharm, FASCP, FAPhA, a co-owner of Osterhaus Pharmacy in Maquoketa, I A. The study investigated how Medicare Part D MTM programs in 2010 affected Medicare patients’ adherence, quality of prescribing, drug safety, resource utilization, and costs of hospital and emergency department care. The study focused on patients with congestive heart failure, chronic obstructive pulmonary disease, and diabetes. This is the first MTM study targeting chronically ill Medicare patients. Previous research on MTM has been conducted by private organizations and payers, and self-starters doing research. Although Part D started in 2006, offering an annual comprehensive medication review (CMR) to en- rollees did not become mandatory until 2010. The CMR was completed for 11% to 14% of patients enrolled in MTM programs in the study population, according to the report. “They compared several MTM programs. Some were more successful than others at reducing overall costs.... Adherence across the board improved” as well as quality of prescribing (use of evidence-based guidelines). When a CMR was completed, the results were even greater,” McManis said. Osterhaus added that the CMR is part of “that ongoing relationship that the pharmacist has with a patient.” While most MTM programs increased drug costs, the best-performing organizations were able to improve medication adherence and quality of prescribing while keeping health care costs, including drugs, from rising. MTM programs that maintained or lowered drug costs were in integrated health systems that also used an electronic health record, according to McManis. MTM programs that decreased costs addressed patients’ cost barriers to adherence by suggesting lower-cost equivalent options to patients and pre- scribers; included MTM components that identify cost-avoidance opportunities; and established care coordina- tion—a working relationship between the provider and the pharmacist providing MTM. “As we move towards patient-centered medical homes and accountable care organizations, pharmacists are a critical member of those teams that can really show high impact [in] improving care and reducing costs,” Osterhaus said. The report “tells me that we’ve got great opportunity out there.” Osterhaus continued, “If we were actually able to provide the services to all the patients who would benefit from it—these targeted patients whom this report shows benefit from it—that would make MTM much more workable at the level of the community pharmacy.” “Globally, [the report] showed that there is a wealth of supporting evidence—clinical, economic, and hu- manistic—that reinforced the role of pharmacists in providing direct patient care services,” said APhA Science Officer Patrick G. Clay, PharmD, FCCP, CCTI. But for any individual pharmacist reading it, “very specific studies” were included that “would be very meaningful to your practice setting.” Clay is Professor of Pharmacotherapy at University of North Texas System College of Pharmacy. “How you can take that report and use it in your own individual practice setting will require the individual to go through the report itself, identify those populations or settings or goals of that individual study that align with [your] specific setting, and see if the methods that were used in that particular project are feasible, align- able, amenable to [your] specific setting,” Clay said. “Instead of you trying to reinvent a wheel, it is a blueprint for you to replicate what has clearly been shown to be successful and beneficial to all parties involved.”