Community pharmacy saves insurer $300 per patient per month with CMM

Continuous medication management (CMM) at community pharmacies can save insurers big money, a new study suggests. The approach not only helps patients stay healthier and out of the hospital, it creates new revenue opportunities for community pharmacies through value-based care contracting, Randy McDonough, PharmD, MS, CGP, BCPS, told McKesson’s ideaShare 2016 in Chicago.

“Can a community pharmacy really have an impact on total patient care costs? The answer is absolutely yes,” said McDonough, who is director of clinical services at Towncrest Pharmacy in Iowa City and Solon, Iowa.

The study

In a pilot study by Iowa’s Wellmark Blue Cross and Blue Shield, mean total care costs were about $300 less per member per month (PMPM) for patients who filled all their prescriptions at Towncrest compared with similar patients who used Towncrest sometimes or not at all. As a result, Wellmark is rolling out a preferred pharmacy plan that pays bonuses for better patient outcomes at a network of more than 100 top-performing pharmacies across the state, McDonough said.

The 12-month observational study ending in March 2015 compared 546 patients receiving all prescriptions at Towncrest with 546 patients matched for age, gender, risk category and utilization receiving no prescriptions at Towncrest. It also compared 340 patients receiving all prescriptions at Towncrest with 340 matched patients receiving some prescriptions at Towncrest.

Total PMPM costs in the all-Towncrest groups were $298 less than the no-Towncrest group (p<0.0001), and $309 less than the sometimes-Towncrest group (p<0.0012). The all-Towncrest groups also showed significantly better medication adherence, McDonough reported.

Back to basics

McDonough credits Towncrest’s success to rigorously applying basic standards of pharmaceutical care whenever patients fill or refill a prescription. This is the CMM approach, which Towncrest combines with medication synching, adherence packaging, and comprehensive medication reviews.

CMM asks three questions:

• What is the patient’s therapeutic outcome? For example: what are blood glucose levels with current diabetes medication?

• Are the patient’s drug therapies effective? For example is the patient reaching HbA1c targets and are glucose levels steady?

• Are the patient’s drug therapies safe? For example, do the patient’s kidneys function well enough to tolerate metformin?

This means probing patients for possible drug-related symptoms and whether they have had relevant monitoring tests. When answers aren’t what they should be, Towncrest pharmacists contact patients’ physicians.

Notes follow the SOAP format familiar to physicians. Subjective information (S), or what the patient says, and objective findings (O), such as blood pressure or blood tests, are used to make the case for a therapy adjustment. This is followed by a pharmaceutical assessment (A) and plan (P), often a proposed medication change.

Physicians are asked to accept or reject the recommendation, and return the signed form. If accepted, the form becomes the new prescription. Documenting the entire intervention is critical.

A 12-month analysis of Towncrest’s CMM program found 2,481 patients received 16,986 interventions (mean of 6.8). Of these, half were drug therapy problems. Physicians agreed with more than 90% of pharmacy-recommended therapy changes, McDonough said. Another 43% of interventions were patient counseling and education.

Towncrest developed its CMM program after McDonough was bought in as part owner when he left academia 10 years ago. It has meant revising workflows, enhancing technicians’ skills, and embracing automation to free pharmacists for direct patient care.

The changes cost money and time, but McDonough believes the results are worth it. CMM improves patient care and Towncrest’s reputation, and brings in new revenues from patient care services.

CMM gives Towncrest a competitive edge in an increasingly value-driven market, McDonough believes. “Patient and provider expectations have changed, and we are changing to meet them.”

Howard Larkin is a freelance writer in Oak Park, Ill.