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PowPak MTM > MTM Module 1: Overview And Definition Of MTM > Flashcards

MTM Module 1: Overview And Definition Of MTM Flashcards

1
Q

MTM is a service performed by pharmacists or other healthcare professionals which has growing relevance in…?

A

Healthcare delivery

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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

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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

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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
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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

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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
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7
Q

CMS refers to MTM as the … of …?

A

Cornerstone of outpatient pharmacy clinical services

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8
Q

What kind of strategy does CMS classify MTM as?

A

Quality improvement

Cost-containment

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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
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10
Q

Who are the main providers of of MTM services?

A

Pharmacists

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11
Q

Pharmacists’ role as … of healthcare services continue to expand in state legislatures and at many organizational levels.

A

Direct providers

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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

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13
Q

MTM is an important part of Medicare, and is being phased in by many states as part of … as well.

A

Medicaid

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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
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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
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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

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17
Q

What are some pervasive problems of the healthcare delivery system that MTM programs help to address?

A

Spiraling costs

Medication errors

Nonadherence

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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

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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)

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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

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21
Q

Where can MTM be performed?

A

In a variety of settings

  • pharmacy
  • medical office
  • health plan
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22
Q

Does MTM require credentialing from payers or institutions?

A

No

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23
Q

Is MTM always done as part of a collaborative practice agreement (CPA)?

A

No

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24
Q

Does MTM require a relationship with the patient’s primary care provider?

A

No

-but it should

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25
Q

What population is Medicare comprised of?

A

Patients over the age of 65 who qualify based on:

  • age
  • financial contributions

Younger age
-due to disability

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26
Q

What are the underlying issues confronting the Medicare population?

A

Costly medications

Multiple chronic diseases

Potential / actual adverse events

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27
Q

Why has Americans’ spending on prescription medications grown exponentially since the 1960s?

A

Aging of the population

Improvements in medical advances

Greater variety of medications available to treat illnesses

Drug cost increases

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28
Q

By the end of 2014, how much was total US healthcare expenditures?

A

$3 trillion

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29
Q

What accounts for more than 75% of healthcare costs and is a major driver of pharmaceutical costs?

A

Chronic diseases

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30
Q

How many Americans live with at least 1 chronic illness?

A

117 Americans

-about half of all adults

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31
Q

What percentage of healthcare spending is for people with chronic illnesses?

A

86%

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32
Q

What percentage of adults have 2 or more chronic illnesses?

A

25%

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33
Q

What percentage do chronic illnesses account for:

Hospital admissions?

RX filled?

Physician visits?

A

81%

91%

76%

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34
Q

People with chronic diseases have more or less doctor visits and hospitalizations?

A

More

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35
Q

Why does healthcare delivery to people with chronic diseases tend to be fragmented?

A

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
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36
Q

What results from poorly coordinated care?

A

May increase:

  • overall costs
  • hospitalization rates
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37
Q

Who are the highest consumers of prescriptions drugs?

A

People aged 65 years and older

-those eligible for Medicare

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38
Q

What are the statistics for Medicare recipients who have multiple chronic diseases?

A

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

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39
Q

What is the fastest growing segment of the population?

A

People over age 85

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40
Q

How many Americans will be over 85 by the year 2050?

A

90 million

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41
Q

What does poly pharmacy bring a heightened risk of?

A

Drug related morbidity and mortality

42
Q

What is the annual cost of morbidity and mortality increasing from?

A

Medication complications

Errors

43
Q

How much can employing the services of a consultant pharmacist reduce the costs of drug related morbidity and mortality in older patients?

A

By $3.6 billion

-from $7.6 billion to $4 billion

44
Q

What is required to offer MTM services?

A

Prescription drug plans

-most are delivered by pharmacists

45
Q

Did the Medicare Modernization Act formally name pharmacists as providers?

A

No

-they cannot receive payments for services directly from Medicare

46
Q

Who can pharmacists bill for MTM services?

A

MTM sponsors

  • through a third party or directly to insurance organizations
  • under 3 different CPT codes
47
Q

Are pharmacists recognized as providers on a federal level?

A

No

The Pharmacy and Medically Underserved Areas Enhancement Act

  • bipartisan bill
  • awaiting passage by the Senate
48
Q

States that offer MTM programs as part of … may provide payments directly to pharmacists

A

Medicaid

49
Q

The services that fall under MTM are well suited for a pharmacist’s:

A

Skill set

Training

Approach to practice

50
Q

Pharmacists have specialized training in areas that relate directly to MTM services, which include:

A

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
Q

What did a 2014 report sponsored by 6 large pharmacist professional organizations report on pharmacists’ roles in the changing healthcare environment?

A

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
Q

What are the roles of Pharmacist Services?

A

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
Q

How is MTM different from other patient counseling services provided by pharmacists?

A

Patient-centered

-rather than product-centered

54
Q

Describe most pharmacy services.

A

Counseling commences when a patient brings in a prescription or refills a prescription
-conversation focuses on the particular agent

55
Q

How is MTM different from most pharmacy services?

A

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
Q

What are the Philosophy MTM goals?

A

Patient-centered rather than product-centered

Focuses on overall regimen rather than individual medication

Collaboration among pharmacists and other healthcare providers

57
Q

What are the Outcomes MTM Goals?

A

Increase patients’ understanding and self-management skills

Improve patient adherence, thereby enhancing efficacy of medications

Increase adherence to CMS quality performance standards

58
Q

What are the MTM Goals Goals?

A

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
Q

A number of recent studies have demonstrated a positive impact of MTM interventions in terms of:

A

Improving patient care

Reducing healthcare costs

60
Q

Evidence based studies have shown pharmacist interventions to have an impact on health outcomes such as:

A

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
Q

What are the positive health outcomes of pharmacist interventions from the Diabetes study?

A

2,247 patients (16 studies)

Significantly reduced Hb A1C levels

62
Q

What are the positive health outcomes of pharmacist interventions from the Diabetes (10 City Challenge)?

A

573 patients (1 multicenter)

Influenza vaccination rate doubled

Eye and foot examination rates increased

63
Q

What are the positive health outcomes of pharmacist interventions from the Diabetes (Asheville Project)?

A

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
Q

What are the positive health outcomes of pharmacist interventions from the Diabetes (poorly controlled) study?

A

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
Q

What are the positive health outcomes of pharmacist interventions from the Hypertension study?

A

2,246 patients (13 studies)

Significantly reduced systolic BP

66
Q

What are the positive health outcomes of pharmacist interventions from the Hypertension, Dyslipidemia study?

A

285 patients (Minnesota MTM program)

637 drug therapy problems resolved (in 285 patients)

HEDIS measures improved for hypertension and cholesterol

67
Q

What are the positive health outcomes of pharmacist interventions from the Congestive Heart Failure study?

A

2,060 patients (12 studies)

Reduced all-cause and heart failure-related hospitalizations

68
Q

What are the positive health outcomes of pharmacist interventions from the Patient Safety study?

A

298 studies

Significantly improved:

  • fewer adverse drug events
  • improved adherence
  • patient knowledge
  • quality of life
69
Q

What are the positive health outcomes of pharmacist interventions from the Primary Care Clinics study?

A

38 studies
-mostly cardiovascular and diabetes

Pharmacist interventions in primary care resulted in improvements in:

  • blood pressure
  • glycosylated hemoglobin
  • cholesterol
  • CVD risk factors
70
Q

What will be the determining factor in how pharmacists implement MTM services?

A

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
Q

To whom can MTM services apply to?

A

Virtually any patient in any practice setting

72
Q

How are MTM services provided?

A

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
Q

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?

A

Time, workflow challenges

Administrative requirements

74
Q

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?

A

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
Q

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?

A

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
Q

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?

A

Nearly all Medicare MTM programs perform phone MTM consult

90% offer in person MTM consult

74% offer telehealth MTM consult

77
Q

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?

A

Pharmacist time spent

Changes in patients’ medications, outcomes

Other impact on pharmacy practice

78
Q

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?

A

See Bonus Module for compensation discussion

79
Q

Who will be invited by the Medicare Part D sponsor to participate in MTM?

A

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
Q

Besides Medicare Part D patients, who else may receive MTM services?

A

Patients:

At the request of their physician

Through their employer

At the invitation of the pharmacist

Self-referral

81
Q

For patients receiving Medicare Part D, the first MTM encounter involves:

A

The Comprehensive Medication Review (CMR)

82
Q

For patients receiving Medicare Part D, what do subsequent quarterly follow-up services include?

A

Targeted Medication Reviews (TMR)

-focus in on the problems identified in the initial comprehensive MTM intervention

83
Q

How is MTM pre-interview patient data collected (when available)?

A

Electronic Medical Record

Pharmacy Records

Paper Chart, Lab Results

84
Q

What is involved in the MTM patient interview?

A

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
Q

Information from the patient interview is used to create what?

A

The Medication Action Plan

86
Q

What proceeds from the Medication Action Plan?

A

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
Q

What proceeds from Changes to Medication Therapies?

A

Prescriber Communication

  • recommendations
  • follow-up questions
88
Q

What occurs after the Medication Action Plan is finalized?

A

Written Medication Therapy Log and Action Plan for Patients

Documentation and Billing

  • pharmacy
  • patient
  • provider
  • payer

Document Patient Issues, Decisions

89
Q

What is the final step of the MTM process?

A

Follow up:

Monitor changes

Document improvements

90
Q

What is used by CMS to determine payments to health plans?

A

STAR ratings

Measure quality and performance

91
Q

Describe the STAR ratings system.

A

1 Star for poor performance

5 Stars for excellent performance

92
Q

What plans are offered a quality bonus payment from CMS?

A

Plans with higher Star rankings

93
Q

What are Star Ratings for Diabetes based on?

A

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
Q

What were Star ratings based on previously?

A

Whether or not Medicare Part D sponsors had performed MTM

95
Q

What are Star ratings based on now?

A

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
Q

What will greatly increase the need for quality MTM?

A

Programs in which reimbursement for healthcare services is provided on a capitation basis
-rather than a fee-for-service basis

97
Q

What increases the demand for improved post-discharge management?

A

Some hospitals under Medicare do not receive reimbursement if a patient is rehospitalized for certain conditions

98
Q

What creates an incentive for efficient healthcare cost savings that can be gained through MTM?

A

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
Q

What do Physician Quality Reporting System (PQRS) measures provide?

A

Standards that must be met in order for physicians to avoid penalties through Medicare

100
Q

What do PQRS programs create?

A

More opportunities for pharmacists to get involved in collaborative practice in an effort to improve quality and outcomes in patient care

101
Q

What are some new opportunities for pharmacists?

A

Patient-centered medical home

Dedicated patient education programs run by pharmacists in hospitals

Creation of employer-sponsored MTM and wellness plans

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