Written by: Joe Osborne, PharmD Candidate, Ferris State University Class of 2020
- MTM offers a wide variety of clinical services, usually provided by a pharmacist
- Affinia Health Network (AHN) has a dedicated MTM pharmacy team
- Priority Health offers incentive dollars for providers through a PCP Incentive Program (PIP)
- Pharmacist EHR access and Collaborative Practice Agreements (CPA) are required through Priority Health to participate in the MTM incentive measure
MTM services improve the quality of patient care, reduce health care expenditures, and decrease medication-related adverse events.1-9 Both the National Academy of Medicine (formerly Institute of Medicine) and the Medicare Payment Advisory Commission recommend that pharmacists be utilized to manage patients’ medications.10,11 Pharmacists are able to provide free MTM services across Priority Health populations (Medicare and Commercial) to not only improve patient outcomes but also complete activities required for primary care providers to earn incentive dollars through the PCP Incentive Program (PIP).
Medication Therapy Management has two arms of clinical service: Targeted Intervention Programs (TIPs) and Comprehensive Medication Reviews (CMRs).
TIPs include, but are not limited to, the following list:
- Adherence monitoring and support
- Therapy gaps
- Therapeutic cost effectiveness
As defined by the Center for Medicare Services, a CMR is “an interactive, person-to-person or telehealth medication review and consultation of a beneficiary’s medications (including prescriptions, over-the-counter medications, herbal therapies, and dietary supplements) by a pharmacist or qualified provider that is intended to aid in assessing medication therapy and optimizing patient outcomes.”
Every recipient of a CMR is required to receive a summary of the service with the following components:
cover letter, patient medication list, and medication action plan.
Priority Health PIP Requirements
To best facilitate care to patients and to meet Priority Health requirements, participation in the Priority Health MTM PIP measure the following is required:
- The pharmacist providing the MTM service has access to the practice Electronic Health Record (EHR) at the time the pharmacist begins providing MTM services.
- The physician and the pharmacist must enter into a collaborative practice that clearly defines their clinical relationship and outlines the duties and responsibilities of both parties. Deadline for CPA submission to Priority Health is December 31, 2019.
- Documentation of a Comprehensive Medication Review (CMR) in the OutcomesMTM platform.
Affinia Health Network 2019 Incentive Dollars
There are two pools of dollars available through Priority Health split into the following categories: Fee-for-service and PIP.
- Fee-for-service encompasses the service payment made to pharmacists for providing CMR and/or TIP service.
- PIP dollars are the result of a Priority Health target goal for completion of CMR per practice site.
Table 1. 2019 Priority Health MTM PIP Incentive
AHN collaborated with Mercy Health leadership and affiliate practices to ensure eligible offices have access to pharmacy resources to complete MTM services. The available pharmacist resource for each office will vary, and may include retail, embedded, and/or the AHN pharmacy team. The AHN pharmacy team consists of two pharmacists, Drs. Tiffany Jenkins and Julie Earby, and three pharmacy technicians who specialize in MTM clinical service.
AHN MTM Initiative: Next Steps
August 2019 – November 2019
- Phased go-live begins at pilot sites including retail and ambulatory clinics in both Grand Rapids and Muskegon regions with a goal to streamline logistics and operations for system-wide 2020 participation
December 2019 – DEADLINE
- Collaborative Practice Agreement submission
- Verification of EHR access
If you have questions about this measure or the requirements to earn the incentive, please contact AHN’s Pharmacy Department at 231-672-3770 or AffiniaPharmacy@mercyhealth.com.
- Fairview. MTM for Employee Health Plan Sponsors. Available at: https://www.fairview.org/services/medication-therapy-management/health-plan-sponsors
- Oliveira, et al. Medication Therapy Management: 10 Year of Experience in a Large Integrated Health Care System. J Managed Care Pharm. 2010; 16(3):185-95. Available at: https://www.jmcp.org/doi/pdf/10.18553/jmcp.2010.16.3.185
- Truong, et al. Potential cost savings of medication therapy management in safety-net clinics. JAPhA. 2015; 55(3): 269-272. Available at: https://ac-els-cdn-com.ezproxy.ferris.edu/S1544319115300583/1-s2.0-S1544319115300583-main.pdf?_tid=3f6c17ba-71b0-4108-bc77-22705e825af2&acdnat=1546691037_65a1af28e630799950b55762d10324d1
- Gazda, et al. Comparison of two Medication Therapy Management Practice Models on Return on Investment. Journal of Pharmacy Practice. 2017; 30(3): 282-285. Available at: https://journals-sagepub-com.ezproxy.ferris.edu/doi/pdf/10.1177/0897190016628962
- Centers for Medicare & Medicaid Services. Center for Medicare and Medicaid Innovation. Evidence Supporting Enhanced Medication Therapy Management. Available at: https://innovation.cms.gov/Files/x/mtm-evidencebase.pdf
- Giberson S, et al. Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011. Available at: https://www.accp.com/docs/positions/misc/Improving_Patient_and_Health_System_Outcomes.pdf
- Barnett, et al. Analysis of Pharmacist-Provided Medication Therapy Management (MTM) Services in Community Pharmacies over 7 Years. J Manag Care Pharm. 2009; 15(1):18-31. Available at: http://amcp.org/data/jmcp/018-031.pdf
- Truong, et al. Potential cost savings of medication therapy management in safety-net clinics. JAPhA. 2015; 55(3): 269-272. Available at: https://www.japha.org/article/S1544-3191(15)30058-3/fulltext
- CDC Best Practice Guide. Domain 4: Community-Clinical Links – Medication Therapy Management. Community Pharmacists and Medication Therapy Management. Available at: https://www.cdc.gov/dhdsp/pubs/docs/Best_Practice_Guide_MTM_508.pdf
- Institute of Medicine. Preventing Medication Errors: Quality Chasm Series. 2006.
- Medicare Payment Advisory Commission. Report to the Congress: Medicare Coverage of Nonphysician Practitioners. 2002.
- Hoorhurst E. MTM Short Review for Pharmacy Students. MTM Short Review for Pharmacy Students.