Pharmacist’s Provided Medication Therapy Management: A Patient’s Ally Against Chronic Diseases Presented by: Kisha Gant, PharmD, BCACP, BCGP, BCPS Clinical Coordinator, Pharmacy Slidell Memorial Hospital
Continuing Education • This Live series activity, Well-Ahead Louisiana Provider Education Network Webinar Series, from 04/26/2018 - 04/26/2019, has been reviewed and is acceptable for credit by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The session titled “ Pharmacist’s Provided Medication Therapy Management: A Patient’s Ally Against Chronic Diseases ” has been approved for 1.0 AAFP Prescribed credits.
Meet the Expert • Kisha Gant, PharmD, BCACP, BCGP, BCPS
Affiliations • I have the following affiliations to disclose: – American Society of Consultant Pharmacists (ASCP) • Medication Safety & Transitions of Care (MSTOC) Workgroup. 2017 – Present – MSTOC Toolkit Update Subgroup Leader. 2017 – Present • Educational Advisory Council. 2017 – Present • Government Affairs Committee. 2017 – Present – American Pharmacists Association (APhA) Alternate Delegate. 2017 – 2018 • New Business Committee. 2017 – 2018
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Objectives 1. Define Medication Therapy Management (MTM) and its components. 2. Identify financial opportunities to sustain your MTM service. 3. Discuss strategies to promote your MTM services. 4. List business, clinical, quality improvement, and other MTM resources.
Question #1 Which one of the following is a patient ‐ centric document containing a list of actions for the patient to use in tracking his/her progress for self ‐ management? A. Personal Medication Record (PMR) B. Medication Adherence Form C. Medication ‐ Related Action Plan (MAP) D. Discharge Summary
Question #2 Which one of the following are MTM ‐ specific billing codes? A. 99605, 99606, 99607 B. 99211, 99212, 99213 C. 99201, 99202, 99203 D. G0108, G0109, G0110
Question #3 You are ready to began providing MTM services. Which one of the following is/are methods to promote your service? A. Bag Stuffers B. Face ‐ to ‐ Face C. Letters D. All of the above
Question #4 There is only one available training program for pharmacists to learn how to provide MTM services. A. True B. False
MEDICATION THERAPY MANAGEMENT (MTM)
Why MTM? • People visit pharmacies on avg 35 times per yr • Pharmacists are the MED EXPERTS • Every $1 spent on MTM = up to $4 saved on overall health care costs • 29% of adults take 5 or more meds • Pharmacist ‐ provided MTM = improvements in A1C , BP , & LDL • U.S. spends $3.5 billion on extra medical costs that result from ADEs • 125,000 deaths per year due to nonadherence www.pharmacytimes.com/publications/directions ‐ in ‐ pharmacy/2014/august2014/pharmacists ‐ as ‐ influencers ‐ of ‐ patient ‐ adherence ‐ http://www.pharmacist.com/toolkit ‐ marketing ‐ mtm ‐ prescribers N Engl J Med. 2005;353:487 ‐ 489 Patterns of medication use in the United States, 2006 Exploring Pharmacists Role in a Changing Healthcare Environment IOM. Preventing Medication Errors: Quality Chasm Series.2006
What is MTM ? Distinct service or group of services that optimize therapeutic outcomes for individual patients and are independent of , but can occur in conjunction with, the provision of a medication product J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
JCPP Definition Now called “ Medication Management Services ” A spectrum of patient ‐ centered , pharmacist ‐ provided , collaborative services that focus on medication appropriateness, effectiveness, safety, and adherence with the goal of improving health outcomes . JCPP Patient Care Process Workgroup’s Recommended Revisions to the Profession’s Medication Therapy Management Definition
MTM Requirements • Patient ‐ specific & individualized services or sets of services provided directly by a pharmacist • Face ‐ to ‐ face interaction between the patient & pharmacist as the preferred method of delivery • Opportunities for pharmacists & other qualified healthcare providers to identify patients who should receive MTM • Payment for MTM consistent with contemporary provider payment rates that are based on the time , clinical intensity , & resources required • Processes to improve continuity of care, outcomes, & outcome measures J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Who Needs MTM? Patients who have: • Experienced transitions of care • Changed medication regimens or insurance coverage • Multiple chronic conditions, providers, or meds • History of nonadherence • Limited health literacy • Desire to reduce healthcare costs • High ‐ risk meds J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
MTM Components 1. Medication Therapy Review (MTR) 2. Personal Medication Record (PMR) 3. Medication ‐ Related Action Plan (MAP) 4. Intervention &/or Referral 5. Documentation & Follow ‐ Up J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Medication Therapy Review (MTR) Systematic process of collecting patient ‐ specific information, assessing medication therapies to identify medication ‐ related problems, developing a prioritized list of medication ‐ related problems , & creating a plan to resolve them J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
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Personal Medication Record (PMR) Comprehensive record of the patient’s medications (prescription & nonprescription medications, herbal products, and other dietary supplements) J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Personal Medication Record (PMR) • Pt name • Date last updated • Pt birth date • Date last reviewed by the pharmacist, physician, or other • Pt phone number healthcare professional Emergency contact info (Name, • • Patient’s signature relationship, phone number) • Healthcare provider’s signature • Primary care physician (Name & phone number) • For each medication, inclusion of the following: • Pharmacy/pharmacist (Name & – Medication (e.g., drug name and phone number) dose) • Allergies (e.g., What allergies – Indication (e.g., Take for…) do I have? What happened – Instructions for use (e.g., When when I had the allergy or do I take it?) reaction?) – Start date • Other medication ‐ related – Stop date problems (e.g., What Ordering prescriber/contact – medication caused the information (e.g., doctor) problem? What was the – Special instructions problem I had?) J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Personal Medication Record (PMR) J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Personal Medication Record (PMR) J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Medication ‐ Related Action Plan (MAP) Patient ‐ centric document containing a list of actions for the patient to use in tracking progress for self ‐ management . J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Medication ‐ Related Action Plan (MAP) • Name • PCP (Name & Number) • Pharmacy/Pharmacist (Pharmacy/Pharmacist Name & Number) • Date MAP Prepared • Action Steps: “What I need to do...” • Notes: “What I did and when I did it...” • Appt info for follow ‐ up with pharmacist J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Medication ‐ Related Action Plan (MAP) J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Intervention and/or Referral Pharmacist provides consultative services & intervenes to address medication ‐ related problems ; when necessary, the pharmacist refers the patient to a physician or other healthcare professional J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Intervention and/or Referral Examples of situations necessitating referral include: – Pt may exhibit problems discovered during the MTR that may require referral for evaluation & diagnosis – Pt may require education to help him/her manage chronic diseases – Pt may require monitoring for high ‐ risk meds (e.g., warfarin, phenytoin, methotrexate) J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Documentation & Follow ‐ Up MTM services are documented in a consistent manner, & a follow ‐ up MTM visit is scheduled based on the patient’s medication ‐ related needs, or the patient is transitioned from one care setting to another J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Documentation & Follow ‐ Up J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
Why Document? Facilitate communication between pharmacist & pt’s other • healthcare professionals regarding recommendations intended to resolve or monitor actual or potential medication ‐ related problems • Improve pt care & outcomes Enhance continuity of pt care among providers & care settings • • Ensure compliance with laws & regulations for maintenance of pt records Protect against professional liability • • Capture services provided for justification of billing or reimbursement (e.g., payer audits) Demonstrate value of pharmacist ‐ provided MTM services • • Demonstrate clinical , economic , & humanistic outcomes J Am Pharm Assoc (2003) 2008 May ‐ Jun;48(3):341–53
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