James Gartner of CareSource and Patty Kumbera of OutcomesMTM shared the first-year results of a cooperative comprehensive medication therapy management (MTM) program that they implemented for nearly 1 million Ohio Medicaid members. As one of the country’s biggest Medicaid managed healthcare plans, CareSource provides consistency across MTM programs, including networking requirements, covered services policies and procedures, quality assurance, and documentation standards and reporting. OutcomesMTM leverages local relationships with pharmacists, patients, and prescribers while using innovative technology.
Through further detailed analysis, Drs Gartner and Kumbera presented findings showing how the MTM is working to improve the health of Ohio Medicaid beneficiaries. Dr Kumbera specifically highlighted that the OutcomesMTM network performance team is “dedicated to providing support, encouragement, and resources pharmacists need to operationalize MTM locally within a community.”
Before the CareSource Ohio program launch in 2012, 400 pharmacies participated. By the end of 2013, that number had more than tripled to 1500 participating pharmacies. Year 1 results also demonstrated that of 106,239 MTM services delivered, 40% were associated with adherence. Most issues related to adherence involved misuse and how patients were administering medications.
Dr Gartner said that in an internal analysis of the Year 1 results, CareSource discovered a return on investment of $4.4 to $1. He reported he was “happy with the results.”
Both presenters said the case findings are promising. These include the following:
Pharmacists have become health coaches and part of the healthcare team—pharmacists are allowed to practice at a high level of the profession
MTM, when implemented using a standard process, looks similar for Medicare and managed Medicaid
Leveraging local pharmacy relationships allows for scalability
Intense network management is key to MTM’s program for success
A focus on quality of care is prevalent across all population types, and MTM can be a tool to improve quality
Based on the results of this case, MTM has demonstrated a positive ROI for managed Medicaid. As for future actions of the program, Drs Gartner and Kumbera say they want to enhance coordination of care by “building a bridge between MTM program and case management” as well as learning how to leverage local pharmacist relationships more effectively.