Terry McInnis, MD MPH President- Blue Thorn, Inc - Mobile Co-Chair- Center for Public Payer Implementation Co-Lead Medication Management Task Force The Patient –Centered Primary Care Collaborative © Blue Thorn, Inc. 2011, All Rights Reserved

ASSESSMENTCARE PLANEVALUATION Ensure all drug therapy is indicated, effective, safe and convenient. Identify drug therapy problems Resolve drug therapy problems Achieve goals of therapy Prevent drug therapy problems Record actual patient outcomes Evaluate status in meeting goals of therapy Reassess for new problems Continuous Follow-up University of Minnesota School of Pharmacy now Medication Management Systems, Inc defined process

 285 MTM patients and 252 comparison group – all BCBS Minnesota health plan members  Delivered by Fairview Health System clinics pharmacists using a consistent and systematic care process  Targeted Patients-  1 of 12 Chronic Conditions in Adults and  2 or more health care claims (related to those conditions) in last 12 months  Findings  Had an average of 6.4 medical conditions and 7.9 drug therapies per MTM patient Isetts, et al. J Am Pharm Assoc. 2008;48(2): )

637 Drug Therapy Problems Identified Minnesota MTM Services Needs Additional Drug Therapy 33.9% Unnecessary Drug Therapy 6.0% Ineffective Drug 11.6% Dosage Too Low 19.9% Adverse Drug Reaction 14.1% Dosage Too High 4.9% Noncompliance 9.6% 100% Indication Effectiveness Safety Compliance Isetts, et al. J Am Pharm Assoc. 2008;48(2): )

 Clinical Results Improved!  Goals of therapy improved from baseline 76% to 90% after MTM  2.2 drug therapy problems per patient identified and resolved –  HEDIS Hypertension criteria achieved in 71% of MTM patients versus 59% comparison group  HEDIS Cholesterol criteria achieved in 52% of MTM patients versus 30% comparison group Isetts, et al. J Am Pharm Assoc. 2008;48(2): )

$11,965 $8,197 Isetts, et al. J Am Pharm Assoc. 2008;48(2): ) Total health care cost: 31.5% Total health care cost: -31.5% Facility costs -57.9% Professional costs -11.1% Drug costs +19.7% MTM services provided a 12:1 ROI

 706 patients with 1721 encounters  Delivered by community pharmacists using the Assurance system and a standardized approach  Average age 70 with 17.8 medications taken for 11.4 conditions 5205 drug therapy problems were identified and resolved 202 patients (28.6%) had > 10 drug therapy problems

Unnecessary Drug Therapy 104 2% Needs Additional Drug Therapy 2,217 43% More Effective Drug Available % Dosage Too Low % Adverse Drug Reaction % Dosage Too High % Noncompliance 1, % Total 5,205 Number of DTP Indication Effectiveness Safety Compliance

 Blood Pressure  Cholesterol Percent not at goal (Initial) Percent not at goal (final) Significance Systolic64%45% p < Diastolic21%14% p < Percent not at goal (Initial) Percent not at goal (final) Significance Total Cholesterol 27%13% p < LDL 38%34% p < Triglycerides 62%41% p < Significant Improvements in Clinical Goals of Therapy!

706 patients 1721 encounters Through Dec 30th 2010 # of events$ Savings Clinic outpatient visit avoided 1382$95,068 Specialty office visit avoided 517$157,168 Hospital admissions avoided 74$469,880 Laboratory service avoided 53$905 Urgent care visit avoided 164$13,448 Long term care admission avoided 4$224,000 Emergency department visit avoided 1820$235,144 Total 4014 $1,195,614

 2010 Prescription Cost Savings = $41,340  less than 3.5% of total cost saved/avoided!  Combining medication and health care utilization cost avoidance estimates:  $718 per patient encounter  $1,752 per participating patient Over $1.23Million saved in avoided hospitalizations, ER, long term care, and provider care in these 706 patients!

2%6% 37% 26%29% % of Patient Encounters Patient Complexity

 An evidenced-based standardized approach with robust IT support to document drug therapy problems, communicate with patients and providers, and bill for services is critical for payer and provider acceptance.  Adequate reimbursement for clinical pharmacist services including a payment shift from Part D for MTM to Part B for CMM, Medicaid payment, commercial and self- insured is critical to support the practice

 Patient, payer, and provider acceptance occurs with documented rapid improvement in clinical outcomes and reductions in total healthcare costs (including reductions in hospitalizations, ER visits, and improvement in provider/prescribers time efficiency/productivity).  For success, we will need a large shift of pharmacists from dispensing activities to engagement as providers of direct patient care with a simultaneous financial realignment from dispensing to payment for professional services. For additional information on the training and IT platform utilized in these studies originally developed by the Univ. of Minnesota School of Pharmacy visit- Medication Management Systems, Inc. PCPCC Resource Guide- Integrating Comprehensive Medication Management to Optimize Patient Outcomes