MTM Module 1: Overview And Definition Of MTM Flashcards
(101 cards)
1
Q
MTM is a service performed by pharmacists or other healthcare professionals which has growing relevance in…?
A
Healthcare delivery
2
Q
What is MTM essentially?
A
A system of reviewing an individual patient’s medications to make sure the person is on:
The right drug
at The right dose
at The right time
3
Q
How can MTM be done?
A
Targeted manner
-focusing on a single drug or disease state
Comprehensive approach
-ideal
-looks at all the medications a person is taking
—in the context of overall health and lifestyle factors
4
Q
How can MTM provide a valuable service to patients?
A
Enables them to use medications in a manner that is more:
- beneficial
- efficient
- cost effective
5
Q
How can MTM provide a valuable service to Payers?
A
Includes Medicare Part D sponsors and CMS
Helps to promote quality care
Reduces or eliminates:
- unnecessary drugs
- unused drugs
Enhances adherence
6
Q
How can MTM provide a valuable service to physicians?
A
Includes other healthcare providers
Provides drug therapy education for patients
Verifies information that may be incorrect or missing in patient’s records, including:
- patient information
- medication information
7
Q
CMS refers to MTM as the … of …?
A
Cornerstone of outpatient pharmacy clinical services
8
Q
What kind of strategy does CMS classify MTM as?
A
Quality improvement
Cost-containment
9
Q
What does CMS require of all sponsors of Medicare Part D plans?
A
Must establish an MTM program that:
Ensures covered Part D drugs are used to optimize therapeutic outcomes
-through improved medication use
Reduces risk
-of adverse events
Enhances cooperation
-between practicing pharmacists and physicians
May be furnished by
- pharmacists
- other qualified providers
10
Q
Who are the main providers of of MTM services?
A
Pharmacists
11
Q
Pharmacists’ role as … of healthcare services continue to expand in state legislatures and at many organizational levels.
A
Direct providers
12
Q
What allows pharmacists to bill for MTM services provided to patients?
A
Collaborative practice agreements (CPAs)
In some areas
-to prescribe or dispense medications without other oversight
13
Q
MTM is an important part of Medicare, and is being phased in by many states as part of … as well.
A
Medicaid
14
Q
How did MTM become a part of Medicare?
A
With passage of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA 2003)
Introduced Medicare Part D
-the first outpatient prescription drug benefit for patients receiving Medicare coverage
Contained a mandate that certain Medicare Part D recipients with chronic illnesses should receive counseling (often provided by a pharmacist) in an effort to:
- contain costs
- help patients better manage the complex aspects of treating their medical conditions
15
Q
What does MTM generally refer to as?
A
A service between:
-a pharmacist (or other healthcare professional)
and
-and an individual (or caregiver)
to ensure that the person’s overall medication regimen is:
- appropriate for the patient
- effective for the medical condition(s)
- safe in view of comorbidities and other medications being taken
- being administered correctly (at the correct dose)
- able to be taken by the patient as intended
- ensuring right drug, patient, and time
16
Q
What is the consensus definition for MTM services that a coalition of pharmacy organizations have arrived at?
A
A distinct service or group of services that optimize therapeutic outcomes for individual patients…independent of, but can occur in conjunction with, the provision of a medication product
17
Q
What are some pervasive problems of the healthcare delivery system that MTM programs help to address?
A
Spiraling costs
Medication errors
Nonadherence
18
Q
Describe some aspects of medication therapy management that are different from comprehensive medication management.
A
May include CMM as one of its components
May also involve a targeted intervention focusing on one medication or therapeutic area
19
Q
Describe some aspects of CMM that are different from MTM.
A
An important part of MTM
May be done as part of MTM intervention or in other settings
-accountable care organization (ACO)
20
Q
What are the similar skills sets of MTM and CMM?
A
Assess patient
Evaluate medication therapy
Develop and implement plan of care
Follow up and monitoring
Documentation
21
Q
Where can MTM be performed?
A
In a variety of settings
- pharmacy
- medical office
- health plan
22
Q
Does MTM require credentialing from payers or institutions?
A
No
23
Q
Is MTM always done as part of a collaborative practice agreement (CPA)?
A
No
24
Q
Does MTM require a relationship with the patient’s primary care provider?
A
No
-but it should
25
What population is Medicare comprised of?
Patients over the age of 65 who qualify based on:
- age
- financial contributions
Younger age
-due to disability
26
What are the underlying issues confronting the Medicare population?
Costly medications
Multiple chronic diseases
Potential / actual adverse events
27
Why has Americans’ spending on prescription medications grown exponentially since the 1960s?
Aging of the population
Improvements in medical advances
Greater variety of medications available to treat illnesses
Drug cost increases
28
By the end of 2014, how much was total US healthcare expenditures?
$3 trillion
29
What accounts for more than 75% of healthcare costs and is a major driver of pharmaceutical costs?
Chronic diseases
30
How many Americans live with at least 1 chronic illness?
117 Americans
| -about half of all adults
31
What percentage of healthcare spending is for people with chronic illnesses?
86%
32
What percentage of adults have 2 or more chronic illnesses?
25%
33
What percentage do chronic illnesses account for:
Hospital admissions?
RX filled?
Physician visits?
81%
91%
76%
34
People with chronic diseases have more or less doctor visits and hospitalizations?
More
35
Why does healthcare delivery to people with chronic diseases tend to be fragmented?
May consult multiple providers for different issues
- often with poor communication between providers
- due to our healthcare delivery system oriented as an acute care model, rather than a chronic care model
36
What results from poorly coordinated care?
May increase:
- overall costs
- hospitalization rates
37
Who are the highest consumers of prescriptions drugs?
People aged 65 years and older
| -those eligible for Medicare
38
What are the statistics for Medicare recipients who have multiple chronic diseases?
See an average of 13 different physicians
Account for 76% of all hospital admissions
Are 100 times more likely to have a preventable hospitalization versus those with no chronic conditions
39
What is the fastest growing segment of the population?
People over age 85
40
How many Americans will be over 85 by the year 2050?
90 million
41
What does poly pharmacy bring a heightened risk of?
Drug related morbidity and mortality
42
What is the annual cost of morbidity and mortality increasing from?
Medication complications
Errors
43
How much can employing the services of a consultant pharmacist reduce the costs of drug related morbidity and mortality in older patients?
By $3.6 billion
| -from $7.6 billion to $4 billion
44
What is required to offer MTM services?
Prescription drug plans
| -most are delivered by pharmacists
45
Did the Medicare Modernization Act formally name pharmacists as providers?
No
| -they cannot receive payments for services directly from Medicare
46
Who can pharmacists bill for MTM services?
MTM sponsors
- through a third party or directly to insurance organizations
- under 3 different CPT codes
47
Are pharmacists recognized as providers on a federal level?
No
The Pharmacy and Medically Underserved Areas Enhancement Act
- bipartisan bill
- awaiting passage by the Senate
48
States that offer MTM programs as part of ... may provide payments directly to pharmacists
Medicaid
49
The services that fall under MTM are well suited for a pharmacist’s:
Skill set
Training
Approach to practice
50
Pharmacists have specialized training in areas that relate directly to MTM services, which include:
Managing multiple medications and combination therapies
Use of newer and specialized agents
-biologics
Dose preparation and administration of injectable medications and devices
Managing and monitoring for adverse effects and safety issues
Addressing patient adherence problems
51
What did a 2014 report sponsored by 6 large pharmacist professional organizations report on pharmacists’ roles in the changing healthcare environment?
Historically, pharmacists’ role in healthcare centered around dispensing medications
```
Although they receive training in:
-preventive care
-health and wellness
-patient education
Pharmacists have traditionally leveraged their clinical knowledge to review prescribed drug regimens to:
-prevent inappropriate dosing
-minimize drug interactions
```
Pharmacists’ roles have expanded over time to include more direct patient care
Their roles continue to evolve today
52
What are the roles of Pharmacist Services?
Pharmacist-provided MTM
-because accountable care organizations manage the entirety of care, they may look to integrate pharmacist-provided MTM to improve adherence and clinical outcomes while potentially reducing costs
Medication reconciliation
-pharmacist provided medication reconciliation can help reduce medication discrepancies and may be an important component of improving transitions of care moving forward
Transitions of Care
-comprehensive transitions of care programs that utilize pharmacist-provided medication reconciliation will be especially important in the post-hospital discharge setting for patients at risk for hospitalization
Preventive Care Services
-payers and policymakers should explore ways to leverage pharmacists’ accessibility in the community to provide preventive care services
Immunization services
-pharmacists are effective in delivering immunization and screening services
Educational and behavioral counseling
-pharmacist-provided educational and behavioral counseling can contribute to better outcomes in chronic illness and support wellness in the population
Collaborative care models
-collaborative care models that include a pharmacist can help alleviate some of the demand on physician-provided care
53
How is MTM different from other patient counseling services provided by pharmacists?
Patient-centered
| -rather than product-centered
54
Describe most pharmacy services.
Counseling commences when a patient brings in a prescription or refills a prescription
-conversation focuses on the particular agent
55
How is MTM different from most pharmacy services?
MTM uses a more comprehensive approach
- focuses on the patient’s disease state
- and complete healthcare regimen
Examines:
- what medications the patient is currently taking
- what treatments might have been overlooked
56
What are the Philosophy MTM goals?
Patient-centered rather than product-centered
Focuses on overall regimen rather than individual medication
Collaboration among pharmacists and other healthcare providers
57
What are the Outcomes MTM Goals?
Increase patients’ understanding and self-management skills
Improve patient adherence, thereby enhancing efficacy of medications
Increase adherence to CMS quality performance standards
58
What are the MTM Goals Goals?
Mutual goals for pharmacy organizations, patients, and payers
Reduce preventable adverse events associated costs
Reduce medication-related morbidity and mortality
Reduce healthcare costs due to duplicate or unnecessary prescriptions
59
A number of recent studies have demonstrated a positive impact of MTM interventions in terms of:
Improving patient care
Reducing healthcare costs
60
Evidence based studies have shown pharmacist interventions to have an impact on health outcomes such as:
Increased access to services for medically underserved, vulnerable populations
Improved patient safety
Alleviated physician burden for health education and counseling
Adding check/balance system for prescribers to prevent prescribing errors
Improve patient and provider satisfaction
Enhance cost-effectiveness
Improved goal achievement for chronic diseases
61
What are the positive health outcomes of pharmacist interventions from the Diabetes study?
2,247 patients (16 studies)
Significantly reduced Hb A1C levels
62
What are the positive health outcomes of pharmacist interventions from the Diabetes (10 City Challenge)?
573 patients (1 multicenter)
Influenza vaccination rate doubled
Eye and foot examination rates increased
63
What are the positive health outcomes of pharmacist interventions from the Diabetes (Asheville Project)?
12 community pharmacies followed 5 years
Significantly reduced mean Hb A1C
Increased percentage of patients with optimal A1C
Improved lipid levels
Decreased costs of care
Decreased sick days
64
What are the positive health outcomes of pharmacist interventions from the Diabetes (poorly controlled) study?
Retrospective review of 100 patient records
Patients with pharmacist-directed MTM had higher rates of medication adherence and
Lower Hb A1C levels than the non-MTM group
65
What are the positive health outcomes of pharmacist interventions from the Hypertension study?
2,246 patients (13 studies)
Significantly reduced systolic BP
66
What are the positive health outcomes of pharmacist interventions from the Hypertension, Dyslipidemia study?
285 patients (Minnesota MTM program)
637 drug therapy problems resolved (in 285 patients)
HEDIS measures improved for hypertension and cholesterol
67
What are the positive health outcomes of pharmacist interventions from the Congestive Heart Failure study?
2,060 patients (12 studies)
Reduced all-cause and heart failure-related hospitalizations
68
What are the positive health outcomes of pharmacist interventions from the Patient Safety study?
298 studies
Significantly improved:
- fewer adverse drug events
- improved adherence
- patient knowledge
- quality of life
69
What are the positive health outcomes of pharmacist interventions from the Primary Care Clinics study?
38 studies
-mostly cardiovascular and diabetes
Pharmacist interventions in primary care resulted in improvements in:
- blood pressure
- glycosylated hemoglobin
- cholesterol
- CVD risk factors
70
What will be the determining factor in how pharmacists implement MTM services?
Depends on:
The practice format
The scope of MTM
- serving mainly Medicare Part D recipients
- reaching a broader target patient group
The reimbursement structure for these services
71
To whom can MTM services apply to?
Virtually any patient in any practice setting
72
How are MTM services provided?
Rapidly evolving
Past: could only provide MTM within a contracted organization
Present: may provide MTM as
- staff pharmacists
- independent contractors
- part of an interdisciplinary team (patient-centered medical home)
73
What are some of the issues the pharmacist might consider when planning for a new MTM service in regards to: How might MTM services affect workload?
Time, workflow challenges
Administrative requirements
74
What are some of the issues the pharmacist might consider when planning for a new MTM service in regards to: What patient populations will be targeted?
How will patients be recruited?
How will we address the potential problem of too few referrals?
How will issues such as language / cultural barriers be addressed?
75
What are some of the issues the pharmacist might consider when planning for a new MTM service in regards to: What methods will be used to communicate with payers, physicians, and health systems about MTM?
Most Medicare MTM pharmacists use fax or phone to communicate results to physicians
100% mail MTM summary to patient
Other methods include:
- hand-deliver
- email
- fax
- web portal access
76
What are some of the issues the pharmacist might consider when planning for a new MTM service in regards to: Is there a need to create a space or find a space for face-to-face MTM consults?
Nearly all Medicare MTM programs perform phone MTM consult
90% offer in person MTM consult
74% offer telehealth MTM consult
77
What are some of the issues the pharmacist might consider when planning for a new MTM service in regards to: How will we document effects and impact of MTM in the practice?
Pharmacist time spent
Changes in patients’ medications, outcomes
Other impact on pharmacy practice
78
What are some of the issues the pharmacist might consider when planning for a new MTM service in regards to: What compensation systems will be used in our MTM service?
See Bonus Module for compensation discussion
79
Who will be invited by the Medicare Part D sponsor to participate in MTM?
Patients who are enrolled in Medicare Part D who:
Have at least 2 conditions from the chronic disease states listed
-some sponsors require 3 or more
80
Besides Medicare Part D patients, who else may receive MTM services?
Patients:
At the request of their physician
Through their employer
At the invitation of the pharmacist
Self-referral
81
For patients receiving Medicare Part D, the first MTM encounter involves:
The Comprehensive Medication Review (CMR)
82
For patients receiving Medicare Part D, what do subsequent quarterly follow-up services include?
Targeted Medication Reviews (TMR)
| -focus in on the problems identified in the initial comprehensive MTM intervention
83
How is MTM pre-interview patient data collected (when available)?
Electronic Medical Record
Pharmacy Records
Paper Chart, Lab Results
84
What is involved in the MTM patient interview?
Communication
- ask open-ended questions
- be nonjudgmental
- listen
Develop Problem List
- allergies
- ADRs
- any supplement / OTC use
- adherence problems
- perceived lack of efficacy
Focus on Patient needs, Priorities
-what is the number one thing I can do to help you today?
85
Information from the patient interview is used to create what?
The Medication Action Plan
86
What proceeds from the Medication Action Plan?
Patient Education
- why am taking it?
- what can I expect from it?
- what side effects can it cause?
- when do notify my doctor?
Changes to Medication Therapies
- dosage adjustment
- alternative agents
87
What proceeds from Changes to Medication Therapies?
Prescriber Communication
- recommendations
- follow-up questions
88
What occurs after the Medication Action Plan is finalized?
Written Medication Therapy Log and Action Plan for Patients
Documentation and Billing
- pharmacy
- patient
- provider
- payer
Document Patient Issues, Decisions
89
What is the final step of the MTM process?
Follow up:
Monitor changes
Document improvements
90
What is used by CMS to determine payments to health plans?
STAR ratings
Measure quality and performance
91
Describe the STAR ratings system.
1 Star for poor performance
5 Stars for excellent performance
92
What plans are offered a quality bonus payment from CMS?
Plans with higher Star rankings
93
What are Star Ratings for Diabetes based on?
Percentage of members with diabetes who have had services such as:
Eye exams
-to check for diabetes complications
Kidney disease monitoring
HbA1C targets met
94
What were Star ratings based on previously?
Whether or not Medicare Part D sponsors had performed MTM
95
What are Star ratings based on now?
The outcomes of MTM carry more weight as part of the Star rating
Health plans have an added financial incentive for pharmacists to perform MTM effectively in a way that benefits patient outcomes
96
What will greatly increase the need for quality MTM?
Programs in which reimbursement for healthcare services is provided on a capitation basis
-rather than a fee-for-service basis
97
What increases the demand for improved post-discharge management?
Some hospitals under Medicare do not receive reimbursement if a patient is rehospitalized for certain conditions
98
What creates an incentive for efficient healthcare cost savings that can be gained through MTM?
Payers contract with a healthcare organization to cover a certain number patients (covered lives) on a per-patient basis
-in the patient-centered medical home model
99
What do Physician Quality Reporting System (PQRS) measures provide?
Standards that must be met in order for physicians to avoid penalties through Medicare
100
What do PQRS programs create?
More opportunities for pharmacists to get involved in collaborative practice in an effort to improve quality and outcomes in patient care
101
What are some new opportunities for pharmacists?
Patient-centered medical home
Dedicated patient education programs run by pharmacists in hospitals
Creation of employer-sponsored MTM and wellness plans
