When you hear the word “epidemic” what comes to mind? If your mind wanders towards the idea of a rapidly spreading contagion infecting large populations of people, you’re not wrong. Although there’s another type of epidemic – perhaps a more silent one – that often goes unnoticed. The chronic disease epidemic faced in the United States. In fact, according to the Centers for Disease Control and Prevention (CDC), 60% of US adults have at least one chronic condition, and 40% are suffering from two or more! With figures like those, this is a problem keeping many healthcare providers and healthcare leaders up at night. Fortunately, there are potential solutions, so let’s discuss one of the most effective—medication therapy management (MTM).
The rise of chronic conditions
Before tackling how to solve the problem of chronic conditions, it’s important to understand how we got to where we are today, with hundreds of millions of Americans suffering from often preventable chronic illnesses.
At first it seems strange that rates of chronic disease are rising in the US. After all, far fewer people are smoking, statins are in common use to control cholesterol, and technology enables closer communication between patients and their doctors than ever before. So, what gives?
Despite these innovations, two things remain very true:
- Ultimately, patients are responsible for their own behavior and maintenance of their health.
- Social determinants of health play an outsized role in how an individual will be affected by their health conditions.
These two factors also share the fact that they can be extremely difficult for patients to overcome on their own. For example, a patient may know that their health is suffering, but without the support and health literacy to impart proper changes, they can find themselves at a loss for how to move forward in the pursuit of better health.
Likewise with social determinants of health (SDOH). According to health.gov, SDOH factors can be grouped into five domains:
- Economic stability
- Education access and quality
- Healthcare access and quality
- Neighborhood and built environment
- Social and community context
It’s easy to see how a disadvantage in any one of these domains can make it hard for an individual to make the right choices for their health.
Despite the many advancements in healthcare over the last several decades, our healthcare system remains largely fee-for-service, meaning providers are paid for outputs rather than outcomes. To turn the tide of chronic condition management, we must shift to a value-based approach, where providers are rewarded for the health outcomes they create for patients. One significant shift towards value-based care is medication therapy management (MTM). MTM consists of regularly recurring comprehensive medication reviews (CMRs) which allow health plans to take a proactive approach as it relates to the medication use of their members before serious issues arise.
Challenges to chronic condition management
Now we know that chronic conditions are a serious issue and why they became that way, but what challenges stand in our way towards better managing the health of our nation?
Low health literacy
Health literacy is a critical facet to any healthcare strategy. This is because when patients haven’t been given the proper information and education by the healthcare system that is supposed to serve them, they turn to inaccurate or misleading sources, perpetuating a culture of low health literacy. Ultimately, this makes providers’ jobs more difficult and creates a barrier they must break through to properly serve their patients.
Medication is one of the most effective tools in the toolbox of any physicians when it comes to making a positive shift in patient health. But no matter how powerful or effective the medication, it’s rendered useless if patients do not properly adhere to their medication regimens—enter mediation nonadherence. This is the concept of patients not taking their medications as directed for any number of reasons. It could be financial inability to pay for medications, lack of concern about taking medications regularly, or simple forgetfulness. But the result is the same—medications simply cannot work if they aren’t taken properly. This becomes even more clear in patients with multiple chronic conditions that require numerous medications for treatment.
Difficulty of lifestyle modifications
Perhaps the simplest of all barriers to chronic condition management is the difficulty to make lifestyle changes. Even once equipped with sufficient levels of health literacy, a treatment plan, and the necessary medications, some patients still won’t change their behaviors as they should. While it’s difficult to influence human nature, it can be done, and is an important part of long-term health improvement.
The role of medication in managing chronic conditions
As mentioned above, medications are a large part of most chronic condition treatment plans. Take diabetes, for example. As one of the most prevalent chronic conditions, and one that can increase the likelihood of other health problems, managing diabetes is essential. Diabetic patients must be educated by their providers that they cannot miss doses of their medications or take their medications in the wrong dosages, the outcome could be catastrophic. Diabetic patients benefit from multiple medication types to manage their conditions, for example, insulin to control blood glucose and statins to prevent cardiovascular disease.
The same rings true for many chronic conditions. For these patients, medications and their proper administration must become part of a regular routine or habit to get the maximum benefit.
How pharmacist-led services and MTM strategies improve chronic condition management
Chronic conditions can be intimidating and downright scary, especially when considering how ubiquitous they’ve become. However, it’s not all doom and gloom. In fact, in this moment you are probably sitting no more than a few miles from a highly trained healthcare professional who can play a leading role in managing chronic conditions—a pharmacist.
While most of us think of pharmacists as white coat-wearing men and women working behind a counter dispensing medications, they are so much more. Pharmacists are the most highly trained clinicians on medications throughout the entire healthcare industry. They’re also experienced in providing MTM consultations, one of the most effective strategies to controlling chronic conditions through medication optimization.
MTM strategies to supercharge chronic condition management
- Use only licensed pharmacists to deliver MTM consultations: This seems intuitive, but as a cost cutting measure, many healthcare organizations employ pharmacy technicians to call patients and counsel on medications. While pharmacy technicians have an important role to play in the healthcare ecosystem, they simply cannot match pharmacists in their level of clinical knowledge and experience. Pharmacists can break down barriers to health literacy and meet patients where they are in their health journey. Together, pharmacists and patients can create an action plan that consists of reasonable and actionable goals that put the patient on the right track toward better health outcomes. Whether it’s improving diet, going for a daily walk, or tracking medication use, pharmacists can educate patients on the why of their recommendations, rather than simply telling them what they “should” do.
- Employ a virtual-first strategy: For years, MTM was expected to be completed in-person by pharmacists at the retail setting. Between phones ringing off the hook, long lines of impatient customers, and countless administrative duties, most retail pharmacists don’t have enough hours in the day to sit down with each patient and conduct a thorough medication consultation. That’s why some healthcare organizations have moved toward conducting CMRs using a call center staffed by pharmacists. While better than relying on retail, a call center is also flawed. Call centers are inherently inflexible, costly to set up, and require a physical location for the team. A virtual model such as Aspen RxHealth, solves these problems and more. Aspen RxHealth pharmacists work from anywhere in the US as long as they have a compatible, internet-connected device. They also make their own hours, meaning the size of the workforce is variable and can be grown or shrunk to meet consultation volume needs.
- Find an experienced partner: When health plans attempt to bring their MTM programs in-house, they may find out that it’s more than they bargained for. With expensive tech stack requirements, personnel costs, and lengthy setup time, creating a homegrown MTM program is unattainable for some regional health plans. That’s where partners like Aspen RxHealth come in. With the nation’s largest community of on-demand pharmacists, there’s no MTM need we can’t handle. In fact, we’ve already proven ourselves through working with many of the nation’s top health plans.
A keenly focused medication therapy management program might be just what your health plan needs to take your chronic condition management performance to the next level. With highly weighted Star measures focused on medication use specific to chronic conditions, leveraging a pharmacist-led program can be one of the most efficient ways to create an advantage in the extremely competitive Medicare space.