Star Ratings and MTM: Turning challenge into opportunity

Medication therapy management (MTM) may present challenges for pharmacists and patients, but according to a representative of Mirixa, a company that provides such services, the benefits it provides are significant.

For patients with health conditions, MTM can lead to better management of their health, said Ugo Nwachukwu, PharmD, senior clinical program manager, speaking at the annual meeting of the National Community Pharmacists Association meeting in Washington D.C. “We believe this is a program that everyone who takes medication can benefit from.”

For pharmacies, he said, benefits come in the form of opportunities for compensation. In addition, in 2016 Medicare’s Star Ratings for healthcare plans will include a measure analyzing the percentage of patients eligible for MTM who complete appropriate reviews. Health plans are likely to be impressed by pharmacies that help them boost their Star Ratings, he said.

See also: Star Ratings: A big deal for pharmacies gets bigger

According to Nwachukwu, as envisioned by Medicare, MTM isn’t for everyone. Beneficiaries must meet several criteria involving the number of chronic diseases they have (at least two) and the medications they take, although health plans have some leeway to set eligibility requirements. Diabetes and chronic heart failure are among the top targeted diseases.

See also: 3 ways pharmacies can build Star Ratings

Medication reviews

MTM has two components: 

• The comprehensive medication review (CMR), typically an in-person consultation between patient and pharmacist about prescriptions, OTC medications, supplements, etc. The idea, Nwachukwu said, is to “identify and address problems or concerns that patients may have and empower patients to self-manage their medications and their health conditions.”

• The targeted medication review (TMR), a monitoring procedure that must occur at least quarterly for MTM enrollees. It’s designed to monitor unresolved issues, discover any new problems that may have appeared, and determine whether a transition in care has occurred.

For these reviews, a pharmacist doesn’t need to be in contact with the patient, and the reviews can be system-generated. The pharmacist may follow up with the prescriber as needed. 

After undergoing a CMR, patients will receive a packet with these components:

• A cover letter

• A personal medication list

• A medication action plan designed specifically for them, which may include recommendations and positive reinforcement of progress the patient has made.

Documentation

It is important to complete the reviews and document them properly, and to insist on quality, Nwachukwu said. He urged pharmacists to focus on the plan sections known as MAP-6, MAP-7, and MAP-8, which are filled out by the pharmacist or patient.

“This is a very patient-centered document,” he said. “Look at issues the patient is good at and those that need improvement.” But don’t go overboard, he warned, with too many details in the sections that will be seen by the Centers for Medicare & Medicaid Services.

In the space in Section MAP-6 titled “What We Talked About,” for example, it’s not necessary to go into deep detail about patient conversations. A general overview of the most important points from a discussion is better than a litany of the many things that could go wrong with a medication. “If you talk about 10 things, report the top 5,” he recommended.

Pharmacists should also make sure they don’t provide too little information. Nwachukwu pointed to “bad” sample MAP entries. One entry simply lists “discussed all mentioned above” under “What We Talked About.” Another lists “Nothing” under “What Patient Needs to Do” about side effects and regimen problems.

He offered an example of a more effective MAP response. Under “What the Patient Needs to Do” regarding A1c goals, it said: “You said that your Hemoglobin A1C was down to 6% after you had been removed from insulin therapy. This is great! Keep eating a healthy diet and regulating your blood sugar.”

Under “Medication Adherence,” the form entry said: “You are doing very well at keeping up with and taking your medication regularly. Continue to do so and contact your pharmacy if you run into any problems.” And next to a note about the patient’s interest in getting off Zolpidem, the form entry recommends that the patient contact the prescribing physician and consider melatonin treatment.

Why does this kind of detail matter? Because pharmacists who fill out the form “can make an argument about what they did and how well they did it,” Nwachukwu said.

Randy Dotingais a medical writer in San Diego.