Establishing a Web-based program for reimbursement for medication therapy management services

Brewer, Jeffrey; Kumbera, Patty

doi:10.2146/ajhp060320

Cited by 2 publications

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“…12 The information collected during the provision of MTM services over 7 years through 2006 represents perhaps the most extensive MTM database available. Further, the database is particularly suited to quantify changes in pharmacist-provided MTM services over time because it includes detailed information about each intervention, patient-level demographics, and estimates of cost savings associated with pharmacist interventions.…”

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confidence: 99%

Analysis of Pharmacist-Provided Medication Therapy Management(MTM) Services in Community Pharmacies Over 7 Years

Barnett

Frank²,

Wehring³

et al. 2009

JMCP

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159

116

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BACKGROUND: Although community pharmacists have historically been paid primarily for drug distribution and dispensing services, medication therapy management (MTM) services evolved in the 1990s as a means for pharmacists and other providers to assist physicians and patients in managing clinical, service, and cost outcomes of drug therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) and the subsequent implementation of Medicare Part D in January 2006 for the more than 20 million Medicare beneficiaries enrolled in the Part D benefit formalized MTM services for a subset of high-cost patients. Although Medicare Part D has provided a new opportunity for defining the value of pharmacist-provided MTM services in the health care system, few publications exist which quantify changes in the provision of pharmacist-provided MTM services over time.OBJECTIVES: To (a) describe the changes over a 7-year period in the primary types of MTM services provided by community pharmacies that have contracted with drug plan sponsors through an MTM administrative services company, and (b) quantify potential MTM-related cost savings based on pharmacists' self-assessments of the likely effects of their interventions on health care utilization.METHODS: Medication therapy management claims from a multistate MTM administrative services company were analyzed over the 7-year period from January 1, 2000, through December 31, 2006. Data extracted from each MTM claim included patient demographics (e.g., age and gender), the drug and type that triggered the intervention (e.g., drug therapeutic class and therapy type as either acute, intermittent, or chronic), and specific information about the service provided (e.g., Reason, Action, Result, and Estimated Cost Avoidance [ECA]). ECA values are derived from average national health care utilization costs, which are applied to pharmacist self-assessment of the "reasonable and foreseeable" outcome of the intervention. ECA values are updated annually for medical care inflation.RESULTS: From a database of nearly 100,000 MTM claims, a convenience sample of 50 plan sponsors was selected. After exclusion of claims with missing or potentially duplicate data, there were 76,148 claims for 23,798 patients from community pharmacy MTM providers in 47 states. . During the 7-year period, pharmacistprovided MTM interventions changed from primarily education and monitoring for new or changed prescription therapies to prescriber consultations regarding cost-efficacy management (Pearson chi-square P < 0.001). Services also shifted from claims involving acute medications (e.g. penicillin antibiotics, macrolide antibiotics, and narcotic analgesics) to services involving chronic medications (e.g., lipid lowering agents, angiotensin-converting enzyme [ACE] inhibitors, and beta-blockers; P < 0.001), resulting in significant changes in the therapeutic classes associated with MTM claims and an increase in the proportion of older patients served (P < 0.001). These trends resulte...

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confidence: 99%

Analysis of Pharmacist-Provided Medication Therapy Management(MTM) Services in Community Pharmacies Over 7 Years

Barnett

Frank²,

Wehring³

et al. 2009

JMCP

Self Cite

159

116

View full text Add to dashboard Cite

show abstract

“…For example, third-party platforms identify patients that are eligible for MTM services (based on their insurance plan), provide a user-friendly interface to complete documentation and billing, and provide standardized forms to aid in communicating with healthcare providers. 7 , 8 Despite their routine use and positive characteristics, many challenges with these platforms remain. A patient’s health information may be inaccurate, incomplete, and include partial prescription fill histories.…”

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confidence: 99%

Evaluation of an Outpatient Pharmacist Consult Service at a Large Academic Medical Center

et al. 2021

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Objective: To evaluate a novel outpatient pharmacist consult service in a large academic medical center. Setting: Four outpatient pharmacies that are part of a large academic medical center Methods: An outpatient pharmacist consult order was created and embedded in the electronic medical record (EMR). Medical center providers utilized this consult order when identifying patients in need of specific services provided by outpatient pharmacists. Descriptive data about each individual consult was collected including number completed, type of service, and duration. Rate of accepted pharmacy recommendations and patient cost savings were also evaluated. A survey was administered at the completion of the study period to assess provider and pharmacist satisfaction with the service. Patient demographic information was collected for those who had a documented completed consult. Results: A total of 193 consults were completed: 137 immunizations, 37 care affordability, 15 education, 3 polypharmacy and 1 OTC recommendation. 89% of completed consults took pharmacists 20 minutes or less to complete. Of completed care affordability consults (n=31), 55% of patients saved between $100 - $500 per medication fill. Of providers who completed a survey and utilized the service (n=12), 83.3% were extremely satisfied and 16.7% were satisfied with it. The provider acceptance rate of pharmacist’s recommendations was 74%. Conclusion: Implementation of an outpatient pharmacist consult service provided an alternative method for the utilization of pharmacist provided MTM services in outpatient pharmacies at a large academic medical center. The service was well received by both providers and pharmacists.

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Establishing a Web-based program for reimbursement for medication therapy management services

Cited by 2 publications

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Analysis of Pharmacist-Provided Medication Therapy Management(MTM) Services in Community Pharmacies Over 7 Years

Analysis of Pharmacist-Provided Medication Therapy Management(MTM) Services in Community Pharmacies Over 7 Years

Evaluation of an Outpatient Pharmacist Consult Service at a Large Academic Medical Center

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