MTM Medication Therapy Management

What is Medication Therapy Management? From 1996 to 2006, the number of prescription medications dispensed increased more than 50% Drug-related morbidity and mortality increased Adverse drug events in ambulatory patients cost $177.4 billion in 2000 A public health goal for the national public health initiative Healthy People 2020 = Improved medication use

Examples include: Reduce the proportion of older adults withdisabilities who use inappropriate medications Increase the proportion of adults with hypertensionwho are taking the prescribed medications to lowertheir blood pressure Reduce emergency department visits fromcommon, preventable adverse events frommedications

Medication therapy management (MTM) Identify Reduce costs Improved clinical outcome Resolve

Development of MTM Medicare prescription Drug, Improvement,and Modernization Act of 2003 (MMA) putMTM on the health care map as part of theMedicare Part D benefit National standardization by expandingcompensation opportunities for pharmacists MMA allows prescription drug plans to payfor MTM services

What is MTM? Improve collaboration Enhance communication Empower patients Optimize medication use

The model framework for MTM Enhancing patients’ understanding of appropriatedrug use Increasing adherence to medication therapy Improving detection of adverse drug events

5 core components of an MTM service include: Medication therapy review Personal medication record Medication-related action plan Intervention and/ referral Documentation and follow-up

Medication Therapy Review (MTR) Collects patient-specific information Assesses medication therapies Identifies medication-related problems Develops a prioritized list of medication-relatedproblems Creates a plan to resolve them.

Medication Therapy Review (MTR) Patients’ knowledge of their medications Address problems or concerns Enable patients to self-manage

Personal medication record (PMR) PMR is a portable record Tool to self-manage Patients should share their PMR’s at health carevisits

Personal medication record PMR is updated Health care providers have updatedinformation Knowledgeable about their medications

Medication-related Action Plan (MAP) MAP provided at end of MTR Contains information to optimize medication self-management Medication-related issues identified Proposed actions Person responsible for action

Medication-related Action Plan Pharmacist creates in collaboration with patient and healthcare providers For patient - use language patient understands Only items patient can act on Within pharmacist’s scope of practice

Intervention Optimize medication use Enhance continuity of care Encourage patients to use appropriate health care services The value of MTM is determined by the quality of the pharmacist’s interventions

Referral Evaluation of a new problem discovered Education Monitoring of high- risk medications Laboratory monitoring

Documentation and Follow-Up Essential elements of MTM Documentation should be consistent for evaluating patient progress and billing Follow up does not necessarily have to be face to face.

Opportunities in Medicare Part D Dr Jose Luna

Opportunities in Medicare Part D CMS issued new requirements for improvements to MTM programs Most of these requirements became law as part of the Affordable Care Act of 2010 (ACA) According to ACA, starting in 2013, Part D Plan sponsors must offer MTM services

Part D Plan Sponsors services and strategies must include: An annual comprehensive medication review Follow-up interventions as warranted Assess the medication use of individuals who are at risk but not enrolled in the MTM program Automatically enroll targeted beneficiaries Permit beneficiaries to opt out of enrollment in the MTM program

Billing for MTM services 1.Bill with CPT codes 2.Contract with OutcomesMTM and/or Mirixa

CPT Codes for MTM Procedure Code: Medication therapy management service(s) provided by a pharmacist new patient face-to-face with patient initial 15 minutes with assessment and intervention if provided

CPT Codes for MTM Procedure Code: established patient initial 15 minutes face-to-face with patient with assessment and intervention if provided

CPT Codes for MTM Procedure Code: Face-to-face with patient with assessment and intervention if provided each additional 15 minutes (List separately in addition to code for primary service) Use in conjunction with 99605, 99606)

CPT Codes for MTM One CPT in 365-day period Up to seven CPT per recipient in a 365-day period

OutcomesMTM and/or Mirixa Contract with OutcomesMTM and/or Mirixa. Identify patients Identify CMR opportunities (Comprehensive Medication Review) $50 Identify TIPS (Targeted Intervention Program) $20 Drop down selection of services provided Screen claims before submission OutcomesMTM and/or Mirixa sends your facility a check

Workflow Check weekly for eligible patients OutcomesMTM only uploads new opportunitiesweekly MTM Pharmacist contact patients on TIP opportunities Pharmacy clerk contacts patients to set upappointments for CMR’s MTM appointments are scheduled in EHR Patients check in at the pharmacy Private consultation area

Benefits of MTM to the clinic Complete the circle of healthcare to patients Adherent patients decrease need for additional therapy Increase communication and understanding between patient and healthcare providers Assist in overcoming cultural literacy Reduce readmission rates Meaningful use and reconciliation of medications are all areas where MTM could assist the clinic in meeting five star rating for managed care contracts

Benefits of MTM to the Pharmacy Pharmacists spend time doing MTM without classifying it as MTM Increase workflow productivity by scheduling for those long counseling sessions Building rapport and trust with patients Extra revenue

MTM Collaboration in Clinic to improve patient outcome Providers refer patients to MTM Our Billing department refer patients to MTM Our Healthcare Heroes refer patients to MTM

Health Care Reform and MTM: Beyond Part D ACOs (accountable care organizations) and Patient Centered Medical Homes PCMH as model of care includes: Primary care provider Whole person orientation Coordinated and integrated care, including evidence-based medicine Safe and high-quality care Pharmacists can play integral roles in optimizing therapeutic outcomes and promoting safe, cost- effective medication use in PCMHs

MTM Collaboration in Clinic to improve patient outcome Intervention Provider MTM Pharmacist

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