Originally developed in the early 1990’s under the name “pharmaceutical care,” Medication therapy management (MTM) has evolved into an integral component to managing patients’ health. MTM describes consultative services aimed at optimizing the effects of medications for patients. But it’s easier said than done. How do you create an efficient MTM program to keep your populations healthy and reduce your costs? Let’s dive in and find out.
The importance of MTM
To understand why an efficient MTM program is important, let’s first begin with which populations typically qualify. While every health plan has different qualification criteria, generally patients must have several chronic conditions and take multiple medications to manage said conditions. Some health plans even stipulate the dollar amount of a patient’s annual medication spend to qualify. Because of their age and likelihood to suffer from multiple chronic conditions, Medicare-aged patients are the most frequent recipients of MTM services to manage their health.
MTM’s importance lies in its ability to detect, correct, and prevent medication problems for patients.
Detect: During a comprehensive medication review (CMR), a pharmacist spends time speaking with a patient about every medication they’re taking. Through this holistic look at the entire medication regimen, pharmacists can often find duplicative or contraindicated medications.
Correct: After identifying a medication problem, the pharmacist can then counsel the member on appropriate next steps. Pharmacists also engage with the prescribing provider to have the medication error corrected, ensuring the patient has the correct medications.
Prevent: The detection and correction of medication errors prevent serious downstream consequences. As many as 450,000 adults aged 65 and older visit the emergency room due to adverse drug events (ADEs) annually. ADEs cause needless suffering in patients and undue financial burden on the healthcare system.
How MTM services are delivered
MTM can be provided to patients in a variety of ways. Some pharmacies offer in-person MTM consultations when patients pick up their medications. However, the most common method of MTM service delivery is through a call center. Charged with maintaining high quality ratings, health plans often operate in-house call centers to conduct patient outreach. These traditional call center models can be staffed by pharmacists, pharmacy technicians, or even pharmacy students.
Unfortunately, the call center approach has two main inherent flaws that decrease efficiency and the member experience.
- Call centers are inflexible by nature. Creating a call center requires that a health plan hire, train, and retain a workforce to staff the call center. Adding further cost, health plans must have a physical presence with workstations and overhead in which to operate the call center. Due to the varying eligibility of patients to receive MTM, call centers often can’t ebb and flow based on member volume at any given time, generating unnecessary expenses throughout the year.
- Staffing a pharmacy outreach team of professionals other than clinical pharmacists can create their own set of challenges. To reduce costs, some call centers use less-qualified professionals to conduct MTM. However, healthcare’s foremost medication experts—pharmacists— have specialized training and experience to identify medication problems. Shouldn’t we use the most qualified clinician for the job?
Three ways to run an efficient MTM program
Clinical pharmacy services like MTM represent an area of healthcare ripe for change. While a traditional MTM approach is better than no approach at all, there are new methods of care delivery to increase efficiency and improve health outcomes for patients.
- Take a pharmacist-led approach. Pharmacists are often called healthcare’s underdogs because of the general unawareness of their value. As doctorate-level clinicians, pharmacists have undergone extensive education equipping them to manage even the most complex medication regimens. Only through the watchful care of a clinical pharmacist, can we truly be confident that all medication issues are being appropriately identified and addressed.
- Leverage innovative technology platforms. In-person consultations and expensive call centers are no longer the only way to ensure that patients get MTM services. New technology platforms allow pharmacists to work from home, delivering MTM services on their own time. Aspen RxHealth’s nationwide network of over 7,000 pharmacists is matched to patients based on age, language, disease state, and specialty to ensure the best consultation quality, every time.
- Stay flexible. Eschewing a static call center model in favor of an on-demand pharmacist network is the best way to increase MTM program efficiency. Aspen RxHealth’s pharmacists operate in a gig-economy model, similar to popular ride-sharing platforms. This means that no matter how big or small the need for consultations, Aspen RxHealth can deliver. We can even surge or shrink our workforce in accordance with the variability of member eligibility during the year. If you already have an in-house pharmacy team, we can still support you. Through Alliance by Aspen RxHealth, your pharmacists can connect with patients via the Aspen RxHealth platform. If your team ever struggles to complete the necessary number of consultations, our pharmacists are standing by to augment your efforts.
If your health plan is struggling with MTM quality and efficiency or looking to build upon a record of high performance, Aspen RxHealth is here to help. Learn more about how we can help health plans, or drop us a line.