MTM Services: Pharmacists, Don't Miss the Opportunity
MTM services improve patient outcomes and provide pharmacists with new financial opportunities.
The Medicare Prescription DrugImprovement and ModernizationAct of 2003 required privateinsurance plans to offer medicationtherapy management (MTM) programsfor enrollees. MTM is a service thatholds great promise for communitypharmacists. It is an opportunity thatshould not be overlooked because itcan improve patient outcomes and providean additional revenue stream forpharmacists.
Medicare reimbursement for MTMservices is targeted toward beneficiarieswho meet their insurance companie'sMedicare Part D plans' criteriaand the Centers for Medicare & MedicaidServices' minimum guidelines.First, the patient must have multiplechronic disease states. Second, patientsmust be taking multiple Part D?coveredmedications. Finally, patients must belikely to incur $4000 in yearly prescription-medication costs.
Increasing Demand for MTM
"MTM continues to present tremendousnew business opportunities for us.The demand for MTM services hasincreased dramatically, especially formedically complex patients residingoutside nursing facilities," said JosephGruber, president of the AmericanSociety of Consultant Pharmacists (ASCP),during his opening remarks at the association'srecent Senior Care Pharmacymeeting and exhibition.
In an effort to help ASCP membersdeliver clinical services in the communitywithout having to find new patientsand establish business support services,ASCP created the MTM Provider Partnersprogram. It offers opportunities formembers to provide community-basedMTM consulting services. PharmMDSolutions is one of the MTM ProviderPartners looking to ASCP to help themsign up consultant and senior care pharmaciststo deliver MTM services directlyto their contracted enrollees.
The Brentwood, Tennessee?basedPharmMD, launched in 2006, is an MTMcompany that works with pharmacistsand pharmacies through its IndependentContractor Agreement. Thecompany's documentation system andcall-center technology enables pharmaciststo deliver MTM services throughboth face-to-face consultation and telepharmacy.
Brad Tice, PharmD, chief clinical officerfor the company, was a member ofthe team that wrote the accepted clinicaldefinition of MTM approved by 11organizations. He also participated onthe advisory panel that developed theMTM model jointly issued by theAmerican PharmacistsAssociation (APhA)and the National Associationof ChainDrug Stores.
"It is not just aboutthe product. It is abouttaking the medicationscorrectly. If medications are nottaken correctly, patients will never seethe value," said Dr. Tice."Medication error, overuse, andabuse are pressing issues in today'shealth care environment, and, if appliedproperly, the principles of MTMcan go a long way toward preventingthese negative events," he added. "It isexciting to operate on the cutting edgeof such an important health caretrend."
As a pioneer in his field, Dr. Tice was1 of 17 individuals to receive the APhAFellow Award in March 2008. The APhAFellow Award was established in 1987to honor members who have demonstratedprogressive, exemplary service,and achievements in their professionalarea through service to APhA academiesand other national, state, andlocal professional organizations.
When MTM services began underMedicare Part D in 2006, Cardinal Healthstarted offering enrollment assistanceto pharmacists participating in theLeaderNET program. Currently, >3300independent pharmacies are membersof Cardinal's Leader program, whichprovides retail independent pharmacieswith many of the same advantages asretail chains, and about 2200 pharmaciesparticipate in LeaderNET.
Registered Pharmacist Glenn Hall,general manager of Leader MemberServices and vice president of marketingfor Cardinal Health's managed caregroup, said it is crucial for pharmaciststo provide MTM services for 3 main reasons:(1) they help improve patient outcomes;(2) they help reduce health carecosts; and (3) they provide pharmacistswith the opportunity to be reimbursedfor sharing their knowledge and expertisewith patients.
Benefits for Patients
Hall believes MTM offers many benefitsfor patients. "Because MTM serviceshelp patients better understand the purposeof their medications and how tobest use them, MTM services help preventadverse reactions and medicationcomplications, while improving compliancewith prescribed directions. It notonly leads to improved patient outcomes,but also to lower overall healthcare costs."
The LeaderNET program providesmany types of assistance to help pharmacistsbegin MTM services. For example,information for all MTM servicesand network opportunities is availableat www.myleader.com, along with afree pharmacist help line. LeaderPharmacies also sponsored a 17-cityeducational tour to teach communitypharmacists how to provide MTM services,and LeaderNET has been workingwith pharmacists on staff and studentsat the University of Findlay School ofPharmacy in Ohio to coach pharmacistsabout MTM and how to becomeinvolved.
"MTM is an opportunity that all pharmacistsshould take advantage of now,"said Hall. "For MTM to be adopted in thecommercial market, pharmacists muststep up, prove the value of the services,and justify the associated fees. As aresult, all players in the health care supplychain will benefit. To make a sizableimpact, pharmacists will need tobecome very aggressive and train staffmembers to provide MTM support sothat pharmacists can work caseloads asefficiently as possible."
Documentation Is Key
Kurt Proctor, RPh, PhD, chief pharmacyofficer for Mirixa Corp, said that pharmacistsalready have been providingmany elements of MTM. "Historically,however, pharmacists have not done alot of documentation. If we do not document,no one is going to see the valueof the services pharmacists provide."
In addition to providing MTM services,Mirixa Corp is a developer of clinicalsolutions that facilitate pharmacistbasedpatient care services. The companyhas delivered >70,000 MTM serviceswithin its national pharmacy networksince its launch in June 2006. Currently,thousands of pharmacies nationwideuse MirixaPro—the company's ondemandclinical software suite. MirixaPro:
- Delivers comprehensive patientinformation and proactive clinicalalerts to highlight potential opportunitiesfor pharmacists to helppatients with their medication—from education, to staying on theirmedication, to finding better alternatives
- Assists in managing patient relationshipsthrough software designedwith the pharmacist's workflow in mind, including patient queuing,scheduling, documentation, andcontact management
- Streamlines documentation andbilling for pharmacy-based patientcare services
- Creates new opportunities for pharmaciststo be reimbursed for deliveringmedication-related services totheir patients
The company recently launched itsMirixaPro 2.3 product. The program isavailable in >80% of US pharmacies.
Pharmacists wanting to participate inMTM services through Mirixa canreceive online and live WebExtraining. The training programdetails how to use the Web siteand provides specific instructionsin providing and billing forMTM services. Using the onlinesystem, pharmacists can identifypatients who qualify for MTM,schedule face-to-face appointmentsfor patients, document the visit,and bill for services.
Dr. Proctor feels it is crucial for pharmacyto position itself stronger as ahealth care provider. "It is important forpharmacists to be engaging in theseservices. From the patient side, theyhave health care needs, and pharmacistsare in a position to help. Engagedpharmacists result in a higher quality ofpatient care. Pharmacists really need tostand up and do this [MTM]," he concluded.