IPC- Exam 1- MTM Flashcards
Medication Therapy Management (MTM)
Range of services designed to help patients get the most benefit from their medications
- All within a pharmacist’s scope of practice
Helps pharmacists detect and prevent medication-related problems
- Includes side effects, drug interactions, appropriateness of therapy
- Pharmacists have been doing this for years, MTM allows for better documentation and reimbursement - basically they put a name to it so they can get paid
Enhances patient understanding of medications, improves adherence, and improves outcomes
Importance of MTM
MTM helps to prevent medication-related problems
- Adverse drug events cause over 1.3 million emergency department visits each year
- Inappropriate medication usage in the United States costs the healthcare system billions of dollars
Helps to build rapport with our patients
An additional source of revenue for the pharmacy
- Direct and indirect
What is included in MTM?
Developing a medication treatment plan
Selecting, modifying, initiating, or administering medication therapy
Monitoring and evaluating the patient’s response to therapy
Provide education and training to improve patient adherence
Performing a comprehensive medication review (CMR) and/or targeted medication review (TMR)
don’t feel HTN or high lipids
MTM Eligibility Criteria
Must be enrolled in a Medicare Part D Plan (so have to be 65 and older) and:
Have multiple chronic diseases (2+)
Be prescribed (2+) medications covered through Medicare Part D
Be likely to spend more than a predetermined annual amount set by their insurance plan for drugs covered by Medicare Part D (~$4,000)
40+, pre-diabetes
MTM Enrollment
Patients are auto-enrolled into Outcomes MTM by their insurance company
- Drop into Outcomes MTM queue
Insurance companies identify medication-related problems, such as non-adherence, to enroll patients
Five Core Elements of MTM
Medication Therapy Review (MTR)
- Comprehensive (once a year) or targeted
Personal Medication Record (PMR)
Medication-related action plan (MAP) - things you should be doing to improve adherence. possibility stopping OTC
Intervention and/or referral
Documentation and follow-ups
Medication Therapy Review
The systematic process of:
- Collecting patient-specific information
- Assessing medication therapies
- Identifying medication problems
- Creating a plan to resolve them
May include:
- Patient interview
- Identifying allergies and health conditions
- Determining medication and immunization history
- Assessing patient’s values, preferences, and goals of treatment
Personal Medication Record
Comprehensive record of patient’s medications
Should be patient-friendly and useful in self-management
Patients can update regularly and bring them to medical appointments
Med:
atenolol
strength:
how to take it:
use:
prescriber:
Dr. Smith
Medication-Related Action Plan
Patient’s guide to solving medication problems, disease-related problems, or understanding general counseling points
Contains a list of actions for the patient to do following the medication review
Items included in a MAP:
- Patient demographics
- Pharmacist name and contact info
- List of “What I need to do” (with a limit of 4)
Prioritize the most important counseling points
Medication-Related Action Plan
what I need to do
what I did and when I did it
ex:
med: HCTZ
what I need to do: I should start taking this in the morning instead of at night
what I did and when I did it: after my med review with the RPh, I started taking this in the morning instead of at night
Intervention / Referral
Pharmacists can contact doctors directly or have patients contact the doctor
- Determine patient’s comfort level with managing their health
Can call, fax, email, or send a letter depending on office preference
Encourage patients to take charge of their own healthcare
Reasons to refer:
- Patient exhibits problems that require physician evaluation or diagnosis
- Patient requires extensive disease state management
- Patient requires evaluation or lab work for high-risk medications
Provider Communication in Interventions / Referrals
Be clear and concise
Identify yourself
Maybe leaving a message with a nurse or medical assistant
Briefly state the problem
Provide relevant background information
Give your assessment and provide recommendations
Documentation and Follow-up
If you don’t document it – it didn’t happen
Opportunity to show our profession’s value and the value of MTM services
Protecting against professional liability
Facilitate communication between pharmacist and healthcare team
OutcomesMTM
Only patients targeted for CMR or TMR (comprehensive or targetted) may be billed for a service
MTM claims must be submitted within 7 days of patient interaction
Claim Submission Requirements:
- All ‘tabs’ must be checked off and completed in order to create the takeaway summary for patients and submit the claim
- Service delivery, Health profile, Med list, Action plan, Takeaway
Targeted Medication Review
Often, they do not need to be scheduled
- Shorter time spent – narrowed down to specific drugs and issues
Look through the patient profile prior to making the call
Review resources provided on OutcomesMTM resources tab
Targeted Medication Review
Example: Finding barriers to adherence
healthcare access
- med is to hgh - contact manufacture if there is a Rx plan or something
- patient taking differently than written direction
- refill request delay
- transportation limitations
med. factors
patient factors
Scheduling the CMR
Tell the patient what to expect
“I’m calling because it looks like your insurance will pay for you to have a yearly medication check-up with a pharmacist”
“I would talk through all of your medications to see if there are any opportunities to maximize your prescription benefit”
“For example, I noticed that….”
Instruct patient to bring all medications or have them ready
- Includes herbals, vitamins, other OTCs
- Even things they only take or use occasionally
Tips for patient acceptance
Timing the appointment for when it works best for them
- Could align with refills of prescriptions
Establishing a pharmacist-patient relationship through other services
Information them that the medication review could save them money
Emphasize 1:1 time with the pharmacist to answer any questions and address concerns
Preparing for the CMR
Gather med list
- Compare OutcomesMTM med list and pharmacy med list
Determine disease states
- Be ready to ask the patient about any discrepancies
Identify healthcare providers or caregivers
Run drug interaction check on patient’s meds
Providing MTM Services by Phone
Due to current pandemic environment
Smile – make it personal
Ask open-ended questions
Set expectations for the call
Ask for the patient’s help if needed
Don’t speak too fast, don’t ramble
Don’t be afraid of silence
- Let the patient have time to think and speak
Compensate for lack of verbal cues
Step 1 of CMR: Service Delivery
Enter the service delivery method
Step 2 of CMR: Health Profile
Review health information and medication history
Determine which conditions the patient is treating and identify possible allergies or side effects
Step 3 of CMR: Medication List
Review the list of pre-populated medications from the insurance company
- Be careful: medication list may not always be up to date
Compare OutcomesMTM med list to pharmacy records and to what the patient tells you they are taking
Enter directions and indications using patient-friendly language
- No SIG codes or medical terms
Add any missing medications including OTCs
Step 4 of CMR: Action Plan
Arrange problems and actionable items discussed during the CMR in order of importance
Can include noted drug therapy problems or suggested changes
Enter one item per line
Patient-friendly language which is directed at the patient
handing to patient
Step 5 of CMR: Patient Takeaway
Claim must be submitted within 7 days of interaction
If you complete with a patient representative, you must indicate if the patient is cognitively impaired
- Document rationale of why you spoke with who you did
Include pharmacist availability in case patient has questions
Generally mail takeaway to patient
OutcomesMTM Claims Info
Pharmacy receives $10-20 per drug therapy problem identified and resolved
Pharmacy receives $50-75 for CMRs
Various services can be billed:
- Needs therapy
- Incorrect dosage
- Adverse drug reaction
- Cost efficacy alternatives
- Needs immunization
- New/change of therapy
