Moving the needle in Ohio: CDC-funded MTM pilot expanding at FQHCs

Public Health

Pharmacists at three Ohio federally qualified health centers (FQHCs) have helped patients with diabetes and hypertension attain better health through disease state management.

“Much like you see in an inpatient care setting, at Health Partners of Western Ohio, the pharmacist is a member of the team who works collaboratively to support the needs of the patient during medical visits,” said Jennifer Clark, PharmD, director of pharmacy services at Health Partners of Western Ohio, an FQHC in Lima, OH.

Health Partners of Western Ohio is part of a project spearheaded by the Ohio Department of Health (ODH). With a CDC grant, ODH partnered with three FQHC sites that already had established models with pharmacists on the care team. In March of 2014, the team began tracking patients’ blood pressure and glycosylated hemoglobin (A1C) levels after pharmacists provided medication therapy management (MTM) counseling sessions. 

Patients with their diabetes in control increased from 0% to 44.8%, according to data on more than 500 patients who received MTM from pharmacists within a 6-month period at the FQHC sites. Patients with their hypertension in control went from 0% to 68.6%.

From five to seven additional FQHCs in Ohio are expected to come on board in early 2016 as the project moves into its second phase. Some sites will have newly hired pharmacists on staff. With the help of another CDC-funded grant, MTM will expand to some primary care physician practices in Montgomery County, OH, that are partnering with a community pharmacy to develop additional MTM models. 

Ohio’s seven colleges of pharmacy and the Ohio Pharmacists Association also had a stake in setting up the project. These partners have formed the state’s first MTM Consortium not only to coordinate more MTM activities and projects, but also to engage Ohio’s five Medicaid managed care plans in support of MTM for patients with hypertension and diabetes.

Access to EHR system

FQHCs have had electronic health records (EHRs) in place for some time, as physicians there were incentivized as early adopters of the technology years ago. As a part of the FQHC team, pharmacists at the project’s three FQHC sites have access to an EHR system.

“We use a population health management approach,” said Alexa Sevin, PharmD, BCACP, pharmacy director at PrimaryOne Health in Columbus, OH, one of the three FQHC sites along with Health Partners of Western Ohio. “Looking at reports each month, we identify patients who have an A1C greater than 9 or have blood pressure greater than 140 over 90.”

Pharmacy support staff at Primary-One Health help identify patients and schedule appointments for them to meet with pharmacists for MTM consults if they haven’t already been referred and scheduled by their primary care provider. 

Pharmacists and primary care providers can then communicate about the patient through the EHR.

In addition to identifying patients on the front end, the EHR can automatically generate a report each month that includes data for the project. 

The EHR system has been a big component of the project’s functionality and ultimate success. However, pharmacists in general have been left out of EHR adoption, and most community pharmacists don’t have access to an EHR. The federal meaningful use EHR incentive program for early adopters of the technology, which incentivizes the use of EHRs through financial payments, did not include pharmacists directly as eligible providers. 

Barbara Pryor, MS, manager of the chronic disease section at the ODH, said designing a relevant data collection tool for all participating MTM project sites has been a challenge, especially as the project expands from FQHCs that share EHRs to primary care practices and community pharmacies that don’t.

Helping payers see value

Ohio’s managed Medicaid program, CareSource, offers an MTM benefit to beneficiaries. This is one source of reimbursement for pharmacists, but certainly not enough. 

While reimbursement for pharmacists’ services remains a challenge in Ohio—as it does in most other states—supporters of the project are hopeful it can move the needle in Ohio. 

“The ODH project has helped other players look at the data and see our value to hopefully convince payers to do something,” said Magdi Awad, PharmD, director of pharmacy services at AxessPointe Community Health Center in Akron, OH, the third FQHC pilot site. 

In addition, Clark said the movement to an outcomes-based health care payment system requires a team. 

“The story of clinical pharmacy is the story of comprehensive integrated care that supports the triple aim: improved patient experience, improved population health, and reduced health care costs,” said Clark.