Creating innovative models for MTM
Growing up, I often heard it said that change is inevitable. Although I did not fully appreciate the meaning within those words at the time, I do now.
The changes that I am experiencing within my own practice are dramatic and rapid. I did expect to see these types of changes in my career, but I did not expect them to be so fast and extensive. Since we cannot change the past, we must focus on our future.
As I look to the future, I anticipate that new models of pharmacy practice, including the provision of medication therapy management (MTM) services, will emerge. I recently came across an article that examined the integration of comprehensive MTM services in a primary care clinic.1
- The study site was a university-affiliated community-based primary care practice and teaching site for medical residents.The intervention was a 10-step individualized Medication Assessment and Planning (iMAP) program provided by residency-trained, board-certified clinical pharmacists who collectively provided clinical services at the clinic 2 days per week.
- The researchers conducted a prospective, observational 6-month study using a convenience sample of older adults from the clinic.
- The primary outcome was total number and prevalence of medication-related problems (MRPs) identified by the clinical pharmacists at 6 months, and the secondary outcomes were acute health services utilized by study patients.
- During the 6-month period, the pharmacists identified 419 MRPs for 64 patients enrolled in the program, proposing therapy-optimizing plans for each problem to the patients’ primary care physicians. The physicians accepted 94% (392) of these recommendations.
- There was a significant reduction in mean MRPs per patient from baseline to 6 months (4.2 vs. 1.0).
- Acute health services utilized by study patients declined from 8.3 to 5.4 events per 100 person–months.
As health care reform begins to take effect, pharmacists must look for new opportunities to provide MTM services in integrated systems. In this particular study, clinical pharmacists provided services in a primary care practice only 2 days per week for a limited number of patients—and yet, they were able to identify 419 MRPs in 64 patients.
What is most impressive in this research is that when the pharmacists made suggestions to optimize patient therapies, the prescribers accepted the vast majority of them. Because clinical pharmacists were integrated into the clinic, they were able to improve therapy for participating patients, resulting in reduced MRPs and utilization of acute health services. The authors also noted that the physicians were “enthusiastically supportive” of the program.
This provides further evidence that pharmacists can improve patient outcomes by implementing MTM services in a primary care clinic. One significant piece missing from this study, however, was pharmacist reimbursement. As pharmacists explore MTM service models in different practice settings, it is essential to consider payment for these services. Pharmacists provide value to the health care system, and that value should be recognized through newer reimbursement models.
As I look at this and other studies, I see a consistent conclusion: pharmacists can identify drug therapy problems and develop medication action plans to improve patient outcomes, and other providers will support and accept pharmacists in this role. If this is true, then the next logical step is the development of reimbursement models that support pharmacists’ value-added services.
I see the future of pharmacy clearly. In my vision, pharmacists are recognized as integrated and fully accepted members of the health care team. They work closely with patients and prescribers to ensure that patients adhere to optimized therapies and achieve positive outcomes. Payers recognize the value of pharmacists and provide adequate reimbursement to support their services.
I know that this vision is shared by many of my colleagues. The task before us is to get patients, other providers, payers, legislators, and other key stakeholders to share that same vision.
Roth MT, Ivey JL, Esserman DA, et al. Individualized medication assessment and planning: optimizing medication use in older adults in the primary care setting [published online ahead of print May 30, 2013]. Pharmacotherapy.