Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare, discusses how Medication Therapy Management (MTM) services work to improve health outcomes, challenges with the adoption of MTM services, and how CMMI's Enhanced MTM Model addresses these challenges.
Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare, discusses how Medication Therapy Management (MTM) services work to improve health outcomes, challenges with the adoption of MTM services, and how CMMI's Enhanced MTM Model addresses these challenges.
Transcript
How do Medication Therapy Management services work to improve health outcomes? Are there any challenges with the adoption of these services?
Medication Therapy Management (MTM) is a suite of clinical services provided by a pharmacist to help doctors and patients with their medication regimens—to optimize the safety of their medications and have better outcomes.
So, there are 3 components of MTM. One identification, one is engagement, and one is intervention. The identification phase is where a health plan, primarily a payer, will identify a cohort of patients who they believe—or in the case of Part D the government believes—will benefit most from MTM services. The identification part is the easy part. The second part is engagement. That’s a little bit more tricky. In the engagement phase, MTM providers, vendors, need to work to establish trusted relationships with patients and with doctors. Doctors have very busy workflows and significant demands upon them. Patients tend to be cynical about strangers calling them to talk about health issues. So that’s a big challenge.
On the intervention side, once you get that trust and you’re able to have that success of gaining the patient’s and doctor’s trust, having a real conversation about the risks that have been identified and the steps that can be taken to reduce the risk provide results.
Another significant challenge is that, historically, since Part D adopted MTM as a requirement back in the Medicare Modernization Act of 2003, it has become, overtime, just a process driven event. It’s measured in terms of completion rates—how many patients are eligible for MTM services and out of those patients, how many of them have had a Comprehensive Medication Review. Plans are measured on process, rather than on quality, and that’s where the whole purpose of MTM really has been lost.
How does CMMI’s Enhanced Medication Therapy Management Model address these challenges?
The enhanced MTM model is a recognition on the part of the government that traditional MTM, which is process driven, doesn’t provide adequate incentives to health plans to really do what MTM is supposed to do, which is drive better results. So, in the enhanced MTM program, the government has removed—for those plans participating in the 5-year model—the regulatory requirements, the completion rates, all of the administrative burdens that have grown up around MTM in the Part D space, and they’ve charged the plans to innovate.
They’ve said, quite specifically, be as creative as you can be, and figure out how to make this work. What work means is to use MTM, the suite of services that pharmacists provide to doctors and patients, to have an impact on therapeutic outcomes. They’ll be measured, instead of on completion rates, instead of on process, they’ll be measured on reducing actual medical expenditures. The success of the program will be determined on their ability to do that.
ATS 2024: Bridging the Past, Present, and Future of Respiratory Care
May 16th 2024The application of artificial intelligence in medicine is anticipated as a highlight of ATS 2024, with sessions exploring its applications in research, radiological interpretation, and pediatric pulmonology.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Looking Back on ISPOR 2024: Hot Policy Topics, Welcome Focus on Employers, and More
May 10th 2024Kimberly Westrich, MA, chief strategy officer of the National Pharmaceutical Council, reflects on the most valuable learnings from the 2024 meeting of ISPOR—The Professional Society for Health Economics and Outcomes Research, including lively discussions of the Inflation Reduction Act and workshops on value assessment.
Read More
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
Posters Characterize DMD Caregiver Experiences, Impact of Gene Therapy on Caregiving Demands
May 10th 2024Posters presented at the ISPOR—The Professional Society for Health Economics and Outcomes Research meeting explored Duchenne muscular dystrophy (DMD) caregiver experiences and gene therapy’s impact on work opportunities for caregivers.
Read More
A Focus on Women: AUA Best Posters Highlight Female Athletes, Prenatal Care, and Women in Urology
May 9th 2024Three posters from the American Urological Association (AUA) 2024 Annual Meeting focused on urinary incontinence in female athletes, prenatal care for fetuses with spina bifida in California, and the experiences of women residents at the Brady Urological Institute.
Read More