January 2020: Medication Therapy Management (MTM) Program

Key Points

  • MTM includes a wide variety of clinical services, usually provided by a pharmacist
  • In 2019, Affinia Health Network had partnered with Priority Health & pharmacists in the network to enhance MTM opportunities
  • MTM services are planned for expansion in 2020

What is Medication Therapy Management (MTM)?

MTM is an umbrella term that captures a wide variety of clinical services, primarily provided by a pharmacist. Pharmacist provided MTM services have been shown to improve the quality of patient care, reduce health care expenditures, and decrease medication-related adverse events.1-9 Such services are based around providing comprehensive medication reviews that evaluate the use of prescription, over the counter, and herbal products with a goal of optimizing patient outcomes.

MTM Participation in 2019

The focus of work in 2019 had been on MTM eligible patients in the Priority Health population (Medicare & commercial) given the potential for direct reimbursement for the service provided by a pharmacist & the opportunity to earn MTM specific PCP Incentive Program (PIP) funds. Participation required three key items:

  1. Pharmacist access to a documentation & billing platform called OutcomesMTM
  2. Pharmacist access to the practice’s electronic health record (EHR)
  3. Collaborative Practice Agreement (CPA) between providers & pharmacists (i.e. formalized documentation of the partnership between providers & pharmacists)

Timeline:

  • March 2019: Negotiations with Priority Health finalized. These negotiations allowed two things: MTM services provided by pharmacists within our network (both ambulatory & retail based) to count toward PIP completion targets & enhanced reimbursement for the pharmacists for any MTM services they provided. MTM services remain free for patients.
  • April 2019: Approval for pharmacy technician resources secured. The Affinia pharmacy technician team was hired to support the pharmacist resources and to ensure as many eligible patients as possible receive MTM services by providing crucial administrative support including patient outreach & scheduling, allowing the pharmacists to spend more time directly engaging with patients.
  • May 2019: Final attestation provided to Priority Health. Affinia provided a comprehensive list to Priority Health of participating MTM PIP offices & network pharmacists for both employed & interested affiliate primary care practices.
  • July – September 2019: Affinia Pharmacy Technician team hired and trained.
  • August 2019: Contracting with OutcomesMTM (MTM documentation & billing platform) completed. This contract officially allowed for the network’s participation in the Priority Health MTM PIP measure as negotiated with Priority Health.
  • September 2019: Phased roll out of the Priority Health MTM PIP program began. Pharmacists across the network either continued or began providing MTM services as well as receiving enhanced reimbursement for the services provided.
  • November – December 2019: Collaborative Practice Agreement documents finalized.

For more information on the Priority Health MTM PIP program, please see visit Medication Therapy Management (MTM) – What You Need to Know.

The Future of MTM Services at Affinia Health Network

Our initial focus in 2020 will be on continued support of the Priority Health MTM PIP program to ensure full implementation across the network. The team will be closely monitoring progress, performance to target and outcomes of the program to determine how best to expand these services with an ultimate goal to expand participation in MTM services beyond the Priority Health population.

Do you have questions or want more information on the program and participation? Please contact the Affinia Pharmacy Department at 231-672-3770 or AffiniaPharmacy@mercyhealth.com.

References

  1. Fairview. MTM for Employee Health Plan Sponsors. Available at: https://www.fairview.org/services/medication-therapy-management/health-plan-sponsors
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
Julie Earby
About the author

PharmD

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