MTM: Centering the pharmacist in healthcare

UP FRONT IN DEPTH

Call it cognitive services, pharmaceutical care, or pharmacy professional services, medication therapy management (MTM) is starting to come into its own. MTM programs enable pharmacists to help both patients and other healthcare providers stay on top of any medication issues, which in turn may improve the cost effectiveness of prescriptions.

MTM includes patient assessment and comprehensive medication reviews, the creation of a medication treatment plan, the tracking of medication safety and effectiveness, patient medication adherence, and pharmacist-prescriber communications.

"MTM leverages the local pharmacist to serve as the patient advocate - and to work with patients and their various prescribers - to ensure they are on the right medications in right combination, taking them at appropriate time, and getting the right outcome from their prescriptions," said Patty Kumbera, BS Pharm, RPh, chief operating officer with OutcomesMTM, West Des Moines, Iowa. Patients and other healthcare providers see pharmacists as the medication experts, she said. "Let's utilize them and leverage their value to mend this broken healthcare system. "

Medicare Part D includes a mandate requiring Part D prescription plans to include MTM programs. "The rules and regulations for the first several years were quite broad and anything counted," Kumbera said. "But the requirements MTM plans had to meet have become stronger in recent years."

Medical home

One growing role for MTM programs is with the patient-centered medical home (PCMH), which the federal Agency for Healthcare Research and Quality calls a way to improve healthcare by transforming how primary care is organized and delivered. PCMH, also known as primary care medical home, uses local and regional care coordinators to oversee the care received by patients who may have issues with their medications.

One PCMH, CareFirst BlueCross BlueShield in Maryland, uses the OutcomesMTM pharmacist network to work with local care coordinators to provide comprehensive medication reviews for patients who need them, Kumbera said. Local care coordinators identify patients who need MTM and reach out to their local pharmacists, and pharmacists in turn reach out to the local care coordinators. "It is bidirectional," Kumbera said of this communication process.

Catherine Cooke, PharmD, is a pharmacist working with OutcomesMTM to triage CareFirst patients to local pharmacists for medication reviews.  Cooke is president of PosiHealth Inc., Ellicott City, Md., and clinical associate professor at University of Maryland School of Pharmacy in Baltimore. Although MTM is required for Medicare patients, CareFirst has made MTM available to all its members, Cooke said. "Over a million members in Maryland are eligible to get this review," she said.

Cooke trains local care coordinators in how to determine which patients should be referred for MTM services, such as those patients with uncontrolled disease. "The top three factors are: Do the patients have a basic understanding of their medications, are we getting the results we want, and are there any patient concerns," she said.

Provider status

One of the important issues connected with MTM is to ensure that pharmacists be paid for their time in counseling patients, Cooke said. "I am billing through the OutcomesMTM system, which serves as an intermediate here." Being able to bill for these services allows MTM to become a revenue generator for pharmacies, she said, adding that patients appreciate the service, which builds customer loyalty to a pharmacy. 

Pharmacists in the OutcomesMTM network are trained in how to document and bill for their services using what the company calls the Connect (TM) Platform, Kumbera said. "It connects our pharmacists with our payers to manage the whole process." For example, if the pharmacist finds that a patient should not be receiving a medication, he or she will call the prescriber and be paid for that interaction, she said. 

"For the pharmacist, there can be a challenge in how the employer compensates the pharmacist," Cooke said. "Some pharmacy chains encourage MTM or allow it, but there is no direct benefit to the pharmacist." Other chains, she said, give the pharmacist either a financial incentive or a change in practice that allows the pharmacist time for MTM and integrates it into the normal work function.  

Valerie DeBenedetteis a medical news writer in Putnam County, N.Y.