With proper medication adherence increasingly linked to better clinical outcomes and lower health care costs, medication therapy management (MTM) increasingly is being considered as an effective tactic for independent pharmacies to grow their business.
The challenge for
independent pharmacies is how to add MTM as a clinical service in an efficient and effective manner to produce the best possible clinical results for their patients and business results for their stores.
Three types of MTM services for patients
Medication therapy management consists of five core elements¹ and every core element is integral. However, sequence and delivery may be customized to meet the individual needs of patient. The key elements are:
- Medication therapy review (MTR)
- Personal medication record (PMR)
- Medication-related action plan (MAP)
- Intervention and/or referral
- Documentation and follow-up
The three types of MTM are:
1. Targeted Interventions. Targeted interventions are brief in-person or phone consultations between pharmacists and patients that typically focus on a single prescription medication. Averaging five to 15 minutes in duration, these consultations address topics such as barriers to adherence, proper usage, side effects and gaps in care like a patient with high cholesterol not being on a statin.
2. Comprehensive Medication Reviews. Comprehensive Medication Reviews (CMRs) are scheduled, in-person consultations between pharmacists and patients that can average 45 to 60 minutes in length. It’s also one of the Star Rating measures for 2017 that pharmacies are being evaluated for. During CMRs, pharmacists collect patients’ clinical information and medication history, assess prescription and over-the-counter medication usage, identify potential medication-related problems, develop prioritized lists of medication-related problems and create plans to resolve the problems with patients, caregivers and prescribers. Patients receive personal medication records (PMRs) and medication-related action plans (MAPs). Physician prescribers receive documentation of CMRs along with requests to correct any medication-related problems identified during the consultation.
3. Targeted Medication Reviews. Targeted Medication Reviews (TMRs) are short (15 minutes or less) follow-up consultations between pharmacies and patients. They’re done in-person or over the phone typically on a quarterly basis following annual CMRs.
Integrating MTM services into the pharmacy workflow
With each patient requiring anywhere from five minutes to two hours of pharmacist or staff time – depending on the level and intensity of MTM services provided – the resources and expenses required by an independent pharmacy can add up quickly without a strategy to mitigate the impact on operations. Three ways to effectively integrate MTM into the pharmacy workflow include:
1. Technology. The most effective way to minimize MTM operational costs is to integrate the services into the pharmacy’s daily workflow, and a key enabler of that integration is technology. Pharmacies should have online MTM portals as features of their pharmacy management systems. An MTM portal is an application that automatically identifies and schedules patients for targeted interventions, comprehensive medications reviews or follow-up targeted medication reviews depending on the patient-specific health and medication information entered into the pharmacy management system.
2. Staff. A designated staff person like a pharmacy technician should check the MTM portal as part of his or her morning routine. The technician then should forward the scheduled MTM interventions with patients’ medication history to pharmacists. Pharmacists then provide the MTM services by phone or in-person based on the schedule and without interrupting other pharmacy operations.
3. Synchronization. To maximize the efficiency and effectiveness of the interventions, MTM services can be synchronized through the portal with other clinical services. They can be synchronized with prescription pick-ups or refills, previously scheduled prescription pick up days and times that are part of appointment-based medication synchronization programs, and patient education programs like smoking cessation classes or nutritional counseling sessions.
Deploying specific tactics to drive CMR efficiencies
In addition to the automated services provided to pharmacies through their MTM portals, pharmacies need other strategies to ensure the efficiency and effectiveness of the most-intensive MTM service, the comprehensive medication review. Among the tactics pharmacies should consider are:
- Dedicating and blocking off set days and times for CMRs outside of the daily pharmacy workflow.
- Setting a 45- to 60-minute time limit for each CMR session.
- Reviewing a patient’s medication profile before the CMR session.
- Requesting that a patient bring his or her latest diagnostic lab results to the CMR session.
- Identifying potential additional clinical service opportunities that could be presented to the patient during the CMR session.
- Following an established agenda for each CMR session, including time for patient interview; medication review; identification of drug therapy problems (DTPs); development of plan of action to resolve DTPs; and documentation of CMR session.
- Following an established protocol for informing physicians and prescribers of identified DTPs
- Using technicians to document, code and submit CMR sessions for payment.
Best practices for MTM success from high-performing independent pharmacies
Several high-performing
independent pharmacies have achieved success with their MTM efforts. According to these pharmacies, strong implementation and results involve these three areas:
1. Pharmacy staff. Pharmacies should utilize their entire clinical team from technicians to pharmacists to make their MTM services as efficient and effective as possible. For example, technicians and other non-pharmacist staff can monitor MTM portals, identify and flag eligible MTM patients, schedule CRMs, and do pre-intervention preparation and post-intervention documentation. That approach frees up pharmacists to conduct the targeted interventions, CMRs and TMRs.
2. Pharmacy training. Pharmacies should train their entire team about MTM and specifically what MTM services are offered to patients. Pharmacists should know, learn and follow MTM best practices through continuing education classes and other professional educational opportunities. Pharmacists’ therapeutic knowledge of medications must be up-to-date and relevant to pharmacy patients. Vendors, meanwhile, can teach the optimum use of MTM portals and their features to pharmacists, technicians and others.
3. Patient communication. Targeted interventions, CMRs and TMRs are only as useful as the information generated by effective pharmacist-patient communication. Pharmacists should use behavioral coaching techniques and ask open-ended questions. They should speak in patients’ primary language or languages they understand. Body language and facial expressions should convey empathy and caring. Pharmacists should avoid “telling” the patient what to do and instead find the patient’s personal motivation for healthy outcomes and create an action plan together. Follow-up questions at the end of MTM sessions should confirm to patients that pharmacists were listening and to pharmacists that patients understood DTP action plans.
By following these key areas for MTM success – integrating MTM into the pharmacy workflow, using specific tactics to make CRM more efficient and optimizing staff, training and communication – independent pharmacies can drive more clinical value and business value from their MTM programs.
Related: Learn about McKesson’s medication adherence and clinical performance solutions for independent pharmacies.
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