OutcomesMTM: Creating an ‘everyday, every-hour’ business model

Patty Kumbera and Tom Halterman launched OutcomesMTM to create a new business model for pharmacy

When Patty Kumbera, BSPharm, was the pharmacist-in-charge at a Walgreens in Des Moines, IA, staying after hours to call doctors and straighten out a patient’s redundant or conflicting prescriptions was all in a day’s work.

“We didn’t call it medication therapy management [MTM]. We just called it taking care of the patient,” Kumbera told Pharmacy Today. “That’s what pharmacists do.”

Community pharmacists everywhere know what it’s like to squeeze in MTM whenever they can. Tom Halterman, BSPharm, a friend of Kumbera’s, also stayed late to help his patients as pharmacist-in-charge at another Des Moines Walgreens.

“That kind of thing goes on all the time in pharmacies, but it’s not a sustainable business model,” Halterman said. “The health care system needs MTM on an everyday, every-hour basis, not just here and there when the pharmacist can afford to break away.”

Walgreens colleagues and close friends, Halterman and Kumbera longed for a practice model that would allow them to care for their patients in a comprehensive, cohesive way. Within a few years of leaving Walgreens, the two had created just such a model.

Halterman and Kumbera launched OutcomesMTM in January 1999. Today, the nationwide administrator of MTM services is lowering costs for payers, improving outcomes for patients, and providing a way for pharmacists to be reimbursed for what they do with their heads, not just what they do with their hands. OutcomesMTM is constantly adding pharmacists from all practice settings to its network of providers.

Proof of concept

Shared values kept Kumbera and Halterman on similar career paths after Walgreens. They experimented with innovative patient services for a small regional chain, which led to their participation in the first wave of the APhA Foundation’s Project IMPACT. In 1996, they were selected to conduct a demonstration study for Blue Cross Blue Shield (BCBS) of Iowa. The health insurer wanted to explore whether pharmacists could save payers money if given opportunities to provide one-on-one patient care.

While the 3-year study did prove that pharmacist-provided MTM would save payers money, by the time it was completed, new leadership at BCBS had decided to move in a different direction. But Halterman and Kumbera couldn’t walk away from the opportunities for pharmacists that the study revealed. It not only showed that MTM could reduce costs and improve care, but it also revealed that payers were just as frustrated with the broken health care system as providers were.

“We said [that] there’s something to bring to the market here. We need to start a company,” Kumbera recalled.

Theory into practice

Drawing their business plan from the BCBS study, Halterman and Kumbera launched OutcomesMTM, an administrator of MTM services that connects a network of more than 65,000 pharmacists trained by the company to provide those services with eligible patients covered by more than 40 health plans. The pharmacists practice in all types of settings, from independent and chain community pharmacies to clinics and private medical practices. Some are consulting pharmacists who do not dispense drugs in pharmacies, but instead provide MTM services full-time from their homes or from libraries, churches, coffee shops, or offices.

“Our vision was to create something that any pharmacist anywhere could deliver,” Kumbera explained. “We have many pharmacists in many practice settings and we embrace all of them. There are so many patients who need [MTM], and there are plenty of patients to go around. There’s no need [to say], ‘These pharmacists shouldn’t be able to do it,’ or ‘These pharmacists are better.’”

OutcomesMTM trains pharmacists to provide MTM services and gets payers onboard to cover those services. The OutcomesMTM Connect platform identifies eligible patients for pharmacists, providing the pharmacists with information to add to what they already know about the patient in order to provide comprehensive MTM services. The pharmacist then bills these services to the patient’s insurer through OutcomesMTM.

Professional satisfaction

Pharmacists who provide MTM through OutcomesMTM avoid many of the frustrations that plague so many community pharmacists. Sade Osotimehin, PharmD, who provides MTM through the company at Walgreens in Baltimore, says her job satisfaction has increased “1,000%” since becoming an OutcomesMTM provider.

“It’s rewarding to utilize the knowledge from 6 or 7 years of school to help patients,” Osotimehin told Today. “The pharmacy is going to get reimbursed for it, so we’re getting the time and permission to provide these services.”

For Osotimehin, OutcomesMTM brought relief to a workday that had become predictable. “It was basically the same thing every day. OutcomesMTM coming along was huge. I’m happier when I’m solving problems,” she said.

Pharmacy outside the box

Among the services OutcomesMTM pharmacists provide are comprehensive medication reviews, targeted interventions, and the resolution of drug therapy problems that pharmacists find through their face-to-face interactions with patients.

Comprehensive reviews take place by appointment with the pharmacist. The pharmacist reviews the patient’s entire medication list, both prescription and OTC, identifying any potential interactions, unnecessary medications, gaps in care, and opportunities to save money.

While community pharmacists typically hold these appointments at their stores, consulting pharmacists can be found providing MTM services in a number of public spaces. Consulting pharmacists serve patients who are eligible for OutcomesMTM services but don’t have access at their pharmacy.

Leslie Kanoskfy, BSPharm, provides MTM services wherever her patients are comfortable meeting her. A community pharmacist for 19 years, Kanoskfy felt that over the years, community pharmacy allowed less and less time for the one-on-one patient care that she most enjoyed. So she resigned and went to work consulting for OutcomesMTM full-time.

“Senior citizen [patients] are sometimes more comfortable meeting me in a public place. I’ve gone to Starbucks, their local pharmacy, or a public library,” Kanoskfy said. Once her patients know and trust her, she will visit them at their homes and teach them how to use blood pressure machines and other medical supplies.

Pharmacists also perform targeted interventions, which arise from TIP (Targeted Intervention Program) alerts sent to the pharmacist by OutcomesMTM. The company’s Insight software, programmed with protocols based on best medication practices, identifies potential medication issues, such as a prescription that a patient hasn’t had refilled, and sends a TIP alert to the pharmacist, who can contact the patient and, if necessary, the doctor to resolve the problem. These alerts, for example, may identify post–heart attack patients who are not taking a beta-blocker or patients with asthma who are overusing their rescue inhalers and not taking preventive medications.

Osotimehin once received a TIP alert that a patient wasn’t refilling her cholesterol medication on time. When she called the patient to find out why, “Her answer was, ‘I have to decide if I am going to put groceries in my fridge or take my medication,’” she recalled.

The patient’s doctor had recently switched her from a statin that cost $5 per month to one that cost almost $50. The patient only refilled the prescription when she had extra money. Because Walgreens and the patient’s insurer both contract with OutcomesMTM, Osotimehin was able to call the patient’s doctor and adjust her medications.

This intervention lowered the cost of the patient’s medications and perhaps helped her avoid hospitalization in the long run. That’s how Halterman and Kumbera, the company’s CEO and COO, have sold OutcomesMTM to so many health plans.

OutcomesMTM gets outcomes

Osotimehin’s experience is common, as 75% of patients flagged by OutcomesMTM’s TIP system for underusing cholesterol medications improve their adherence. About 70% improved asthma and psychiatric medication use through this system as well. The company has also seen improvements in use of blood pressure medications and reductions in inappropriate use of medication by older patients.

Improving medication adherence doesn’t happen with comprehensive medication reviews or targeted interventions alone. As Halterman said, MTM is needed everyday and every hour. That’s why Kanoskfy follows up with her patients regularly by phone.

“Sometimes there are patients who are very vulnerable, like the one with 400 [mg/dL] blood glucose whom I call once a month,” Kanofsky said. “If everything is going okay, I’ll check in with them every 2 months. Some I call every week, just to make them accountable to me, because if one isn’t using his treadmill, I’m going to say, ‘Why not? What happened?’ … It’s so rewarding. It’s so wonderful. This is the way pharmacy should be practiced all the time.”

Dozens of health plans seem to agree. Many plans that contract with OutcomesMTM initially do so to offer required MTM services to their Medicare Part D patients—just one segment of their patient population. These payers often decide that they could increase their savings by extending the benefit to non-Medicare patients as well, including commercial, self-funded, Medicaid, and Medicaid managed care patients.

“We work with some pretty hard-nosed CFOs,” Halterman said. “If they’re willing to invest health plan dollars in MTM services when they’re not required to, it’s because they’re seeing a return on it. We’ve had clients say, ‘Why would we offer this program to just a small percentage of our population?’ That growth and expansion are what I see as one of the most positive trends out there for pharmacy.”