Medication therapy management (MTM) programs provide opportunity for pharmacists to help improve patient outcomes and increase their bottom line. It also drives home the message that pharmacists are the most accessible health care providers.
The Medicare Prescription Drug Improvement and Modernization Act of 2003 required all private insurance plans to offer MTM programs for all enrollees. For pharmacists to be reimbursed from Medicare for MTM services, patients must have multiple disease states; patients must be taking multiple Part D–covered medications; and patients must be likely to incur $4000 in yearly prescription medication costs.
Successful MTM services take a practice- based approach. Pharmacy Times interviewed industry experts and asked about their 10 best practices for providing MTM services.
Edward J. Staffa, RPh, vice president of pharmacy at Mirixa Corp, which administers MTM services, said:
- Document, document, document: For pharmacists to get reimbursed for MTM services, they must document the services provided. Documenting tells a story in a complete way and allows payers to see what service they are reimbursing.
- Delegate, delegate, delegate: Many pharmacists report that they cannot find the time to offer MTM. It can be done if pharmacists, for example, use their technicians to take the patient's medical history. This allows pharmacists more time for providing an MTM service.
- Schedule smart: Pharmacists need to determine when is the best time to offer MTM. Pharmacists may choose to provide MTM on the pharmacy's slow day. They can have staff come in early to help cover the pharmacy while the pharmacist conducts MTM services.
- Assess workflow: Have an environment that is conducive to MTM. This means looking at how the pharmacy handles workflow in getting prescriptions filled and other responsibilities of the pharmacy staff.
- Partner with providers: Pharmacists should reach out to physician offices to explain the MTM services they offer and get physicians onboard to recommend patients to a pharmacy for MTM services. A second approach is to partner with pharmacy schools by having pharmacy students work in the pharmacy to give them realworld, practical experience.
- Create the setting: To provide MTM services, pharmacists need to have a private area, such as an area with a curtain.
- Educate yourself: It is important for pharmacists to keep themselves on the cutting edge of what MTM is about. Take continuing education lessons that focus on MTM.
- Educate patients: Research has shown that patients have no idea about the purpose of MTM. MTM is only as good as you deliver and communicate to the patient.
- Bone up your business: MTM has both a professional and business element. Assess how to make it pay.
- Start slow, start somewhere: The landscape of MTM in community pharmacy reflects that there are not enough cases to make a profit. Start out with a few cases, and build on as you feel more comfortable offering MTM services.
Outcomes Pharmaceutical Health Care's administrator of MTM, Patty Kumbera, BPharm, cofounder and chief operating officer, and Brand Newland, PharmD, vice president, said:
- Courage: Pharmacists need to have courage to consult with physicians and to ask difficult questions of patients.
- Avoid "paralysis by analysis": Get started with MTM services and refine them as you go, rather than attempting to be perfect on day one.
- Establish goals: Pharmacists need to set goals for MTM service delivery, such as achieving a "Best in Class" designation or resolving a specific percentage of drug therapy problems identified.
- Empower technicians: Pharmacy technicians are a valuable asset in MTM-related activities, such as assisting with patient identification, scheduling of appointments, and billing.
- Provide a master medication list: Each patient should be given a master medication list at the end of the comprehensive medication review service and help the patient to keep it updated.
- Educate patients: Pharmacists need to educate patients about the MTM services they can provide and the unique and valuable role pharmacists play in their health care.
- Keep pro-bono work to a minimum: If pharmacists expect commercial payers to compensate them, they need to charge for their services.
- Use available resources: Pharmacists should take advantage of assistance from MTM program administrators, information available from pharmacy professional associations, and advice from colleagues.
- Incorporate MTM into workflow: Pharmacists need to make MTM part of their daily workflow and make these activities routine.
- Proper technology: Ensure the pharmacy has high-speed Internet connectivity.
Rebecca Chater, RPh, MPH, FAPhA, president, KDI Health Solutions LLC, director of clinical services, Kerr Drug Inc, has been invested in providing MTM services for a decade. She said:
- People/team: The people are the most vital element of a successful MTM practice. For successful MTM services, individuals need to complement one another and understand the value of collaboration and being a strong team player.
- Passion for patient care: Pharmacists who have a passion for patient care are the only pharmacists who will be truly great at providing clinical pharmacy services.
- Common unifying vision: In the quest to create a new reality of caregiving in the community pharmacy, all parties involved in patient encounters must share a common vision for change-the evolution of traditional community practice to clinical community practice.
- Create a system: Pharmacists providing MTM services should implement a system that allows them to focus on what they are trained to do-what only they can do with their knowledge and skill set.
- Eliminate distractions or lower-level tasks: Pharmacists need to concentrate on the tasks only they can perform. Pharmacy staff, for example, can call patients to schedule appointments.
- Outcomes-oriented practice: The practice is important, but the outcomes are more important. The ultimate difference is not the process, but the outcome for the patient. How does the service the pharmacist provides help the patient? Does the patient feel better? Does the service the pharmacist provides reduce total health care cost?
- Share best practices: It is important to share best practices with like-minded pharmacist colleagues. When a colleague finds a process that works, everyone needs to learn from it.
- Patient care experiences: Clinicians today like a mix of responsibilities so they are not doing the same thing. It keeps them fresh, motivated, and creative.
- Interaction with other health care disciplines: Pharmacists need to have a good working relationship with other health care providers, such as physicians, nurses, and dietitians, in this patient-centric model.
- Pay for performance: Ultimately, pharmacists will welcome MTM, as long as the metrics are clearly defined and meaningful. The worst is for clinicians to be caught in pay-for-performance measures that are not defined.