In 2010, only about 8% of Medicare Part D enrollees who were eligible for a comprehensive medication review (CMR) received one, according to CMS. Cynthia Tudor, PhD, Director of the Medicare Drug Benefit and C and D Data Group, predicted last March at the CMS 2012 Medicare Prescription Drug Benefit Symposium that the number of eligible patients who receive the review will rise as more patients become aware of MTM and its value.
But how can providers reach all of these patients to explain the value of MTM? Randee Bowder, BSPharm, believes they’re just a phone call away. Her Oregon-based firm MTMCare, which she runs with partner Nicole Schrankel, PharmD, coordinates telephone-based MTM provided by 10 pharmacists across nine states. Her team conducted more than 1,200 CMRs just this year.
“The opportunity is huge, and we think that phone-based is the key,” Bowder told Pharmacy Today. “But we want to be clear: We are not some call center somewhere. The service we provide is connected and caring.”
Bowder may be on to something—MTMCare’s prospective patients agree to CMRs at a rate of 83%. A number of MTMCare’s patients live in rural areas without transportation or may be homebound for other reasons and have limited health literacy.
“These patients are not going to talk to a pharmacist for a CMR any other way,” Bowder said. “It’s not a part of their lives to schedule an appointment with their pharmacist and keep it. Only someone that’s very proactive about their health is going to do that. For them to have the opportunity to stay in their homes, have someone call them to talk about their medicines, and then follow up 2 weeks later—it’s a very unique situation. We have a chance to impact lives that we would not otherwise have.”
While Bowder and Schrankel provide unique care for far-flung patients, they are building a unique career for themselves.
MTMCare is positioning itself to acquire patients from multiple sources. Currently, the source is OutcomesMTM, a national company that contracts with health insurance plans, including Medicare Part D, to connect MTM-eligible patients with pharmacist providers. These pharmacists provide MTM as independent consultants or through their community pharmacy employer. Most of OutcomesMTM’s providers deliver services in person. MTMCare, with its phone-based services, reaches many patients who are missed by in-person MTM.
Insurance plans reimburse OutcomesMTM for each patient they serve. OutcomesMTM then reimburses each pharmacist for the service, which includes calling eligible patients, scheduling and carrying out CMRs with those who agree to it, and writing up summaries afterwards and faxing or mailing them to doctors and patients.
In addition to Bowder’s and Schrankel’s individual patient loads, their firm, which is staffed by four associates, takes care of all the preappointment scheduling and postappointment paperwork for MTMCare’s 10 consulting pharmacists and all of their patients.
While it is predominantly phone-based, MTMCare does offer in-person CMRs 1 to 2 days a month at health plan offices. Eventually, Bowder and Schrankel would like to have a pharmacist in every state.
“The idea is to create a call center that can help support all the consultant pharmacists out there who are trying to make MTM work,” Bowder explained. “You don’t get paid for the no-shows, or the faxes to doctors over and over again, or the phone calls that don’t get answered. So we push that out to the associates, so the pharmacists can really focus on providing the billable clinical services that make a difference.”
Both Bowder and Schrankel came to MTM consulting from high-paying, high-stress jobs that had left them completely burned out.
Bowder had worked in community pharmacy since graduating from pharmacy school in 1998. Self-described as entrepreneurial, she quickly saw that community pharmacy wasn’t right for her.
“My biggest problem with retail was autonomy. Clocking in and clock out,” Bowder recalled. “Working till 10:00 [pm] when that doesn’t suit my schedule or my body very well. Standing for 8 hours a day. I had back problems for about a year and a half. As soon as I quit working retail, it went away.”
Bowder had always wanted to run her own business, so she became a certified life coach. But for all the autonomy she lacked in retail pharmacy, she found life coaching a little too fluid.
“It’s not state-regulated. I was coming from pharmacy, which is very structured. This is who’s responsible. This is the license. These are the rules,” she said.
In MTM consulting, Bowder combines life coaching skills with clinical care.
“[Life coaching taught me to] let the clients lead the conversation. That informs how I do the medication reviews and how I train consultants,” Bowder said. “I might say, ‘Oh, you’re not taking your medications every day? What do you think might help you?’ instead of, ‘Get your medication box and fill it up weekly.’ Maybe they’ve already done that, and it’s still not working. So the coaching style is very patient centered.”
For Bowder, the transition from community pharmacy to telephone-based MTM was gradual. First she transitioned from full-time to part-time at a retail pharmacy in order to take on a few patients for OutcomesMTM in 2011. By early 2012, she hired her first part-time associate to help with clerical work. In the fall of that year, business was good enough that she took the leap and left community practice to provide MTM full-time. In January of this year, she invited Schrankel, a hospital pharmacist she’d met at the gym, to be her partner. Together, they leased an office space and hired three more associates.
While many Americans who spend their days working in cubicles disparage the structures, Bowder jokes, “We are very proud of our cubicles.” They’re a symbol of the success of the business she built from a few hours of part-time consulting to a small firm with consultants and associates working under her.
“It’s a very casual, autonomous work environment, where you can wear your gym clothes to work and go for a run at lunch,” she added, gesturing to her own Nike jacket.
Bowder and Schrankel complement each other well. Schrankel, who admits she loves to talk, often offers to take on the potentially difficult patients, and she manages the day-to-day questions and challenges consultants may have. In addition to her own patient panel, Bowder coordinates the initial process of training new consultants and bringing them on board.
Schrankel uses her love of talking to manage patients more efficiently. The phone-based system allows her to give patients the personal conversations she feels they value while she completes paperwork without seeming disinterested.
“Some of the patients live way out in the middle of nowhere,” Schrankel told Today. “They become very talkative on the phone, so I make sure, once we get through all the medical information, history, and counseling, that I just let them talk.”
While Bowder sought autonomy, Schrankel was searching for what had drawn her to pharmacy in the first place.
“Hospital pharmacists are very far removed from patient care. It’s all about trying to meet all the regulations for the Joint Commission, so you’re doing a ton of stuff that’s far removed from the satisfaction that I had once felt,” she said.
Regardless of their individual motivations, Bowder and Schrankel agree on one thing: the telephone offers a unique entry into the lives of some patients that providers may otherwise never reach. They use that entry to make a difference.
Bowder saw this potential when she spoke to an elderly woman in rural Oregon whose husband had recently passed away. The woman had no other support network, and she’d stopped talking all her medications, including one for chronic obstructive pulmonary disease.
Shortly into the phone call, Bowder learned that transportation was the problem, and she connected the woman with a caseworker at her insurance company, who connected her with transportation for the elderly. When Bowder followed up, the woman had seen her doctors and gotten back on her medications.
“That patient sealed the deal for me. She got me really passionate about what we are doing, especially the phone-based part,” Bowder said. “I don’t know what would’ve happened if I hadn’t called her.”
Schrankel shared a similar story about a man in Mississippi who wasn’t picking up his antihypertensive medications. During the call, the patient told Schrankel he couldn’t afford his copay at the doctor, which he believed would be hundreds of dollars.
Skeptical, Schrankel contacted the caseworker OutcomesMTM provided for patients on this particular plan. It turned out the copay was only $5. The patient, who had misunderstood his benefits, then saw his doctor and got his hypertension back under control.
“You wouldn’t have caught this problem at the retail pharmacy,” she said, “because he wasn’t going any more.”