Model for Medication Therapy Management in a University Clinic
Model for Medication Therapy Management in a University Clinic
Purpose: Experience with a referral-based medication therapy management (MTM) clinic in a university medical center is described.
Summary: The MTM clinic's mission is to assist patients who take multiple medications due to multiple chronic conditions with the management of their drug therapy to improve or maintain their health and prevent or minimize drug-related problems. The clinical services provided at the clinic have evolved into a comprehensive program providing five distinct service areas: access, adherence, coordination of care, medication therapy review, and education. During initial visits, patient information is collected, patients are interviewed, medications are reconciled, and the pharmacist identifies and attempts to solve any immediate drug-related problems and concerns. Routine visits are scheduled monthly to coincide with a patient's medication refills. On a typical day, a minimum of two MTM pharmacists and one pharmacy technician staff the clinic. On two days of the week, three MTM pharmacists are available in the clinic. The clinic averages 9-13 scheduled patient visits per day. The MTM clinic functions as a subset of the outpatient pharmacy and is merged financially in the general operational budget of the ambulatory care pharmacy. This model of MTM patient care is intensive and comprehensive and is significantly different from the majority of MTM models currently provided by Medicare Part D plans.
Conclusion: A referral-based MTM clinic managed by pharmacists at a university medical center outpatient pharmacy provides care to patients with the goal of improving medication access, medication adherence, continuity of care, medication therapy management, and patient education.
In the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, a small but significant provision titled Medication Therapy Management (MTM) programs (Section 1860D-4[c] [1] [2]) has created considerable interest within the health care community, particularly in the profession of pharmacy. The provision states that MTM is a service for Medicare beneficiaries who have multiple chronic diseases, are taking multiple drugs covered under the MMA, and are likely to incur an annual cost (set by the Centers for Medicare and Medicaid Services [CMS]) of at least $4000. The MMA identifies three key elements of an MTM program: (1) provision of education and counseling to enrollees to improve their understanding of their medications, (2) improved adherence to medication, and (3) detection of adverse drug events (ADEs) and patterns of prescription drug overuse and underuse. In the final rulings on the MMA, CMS stated that MTM programs must evolve and become the cornerstone of the Medicare Prescription Drug Benefit.
It is unknown what model or structure of MTM will adequately provide the outcomes desired by CMS. A definition for MTM has been established by the Pharmacist Provider Coalition. Although avidly endorsed by members of the pharmacy profession, it is unknown whether the definition will be accepted by others vested in this process (e.g., providers of prescription drug plans [PDPs], insurers, government agencies, other health care disciplines). CMS stated in its final ruling on the MMA that insufficient standards and performance measures exist to support detailed specifications for MTM services or service-level requirements. Research and careful study are needed to define what MTM services and processes will achieve the desired patient care outcomes and the cost:benefit ratio they will provide to the health care system.
We describe an MTM program that has evolved over the past 10 years in the ambulatory care pharmacy at the University of Illinois Medical Center at Chicago (UIMCC).
Purpose: Experience with a referral-based medication therapy management (MTM) clinic in a university medical center is described.
Summary: The MTM clinic's mission is to assist patients who take multiple medications due to multiple chronic conditions with the management of their drug therapy to improve or maintain their health and prevent or minimize drug-related problems. The clinical services provided at the clinic have evolved into a comprehensive program providing five distinct service areas: access, adherence, coordination of care, medication therapy review, and education. During initial visits, patient information is collected, patients are interviewed, medications are reconciled, and the pharmacist identifies and attempts to solve any immediate drug-related problems and concerns. Routine visits are scheduled monthly to coincide with a patient's medication refills. On a typical day, a minimum of two MTM pharmacists and one pharmacy technician staff the clinic. On two days of the week, three MTM pharmacists are available in the clinic. The clinic averages 9-13 scheduled patient visits per day. The MTM clinic functions as a subset of the outpatient pharmacy and is merged financially in the general operational budget of the ambulatory care pharmacy. This model of MTM patient care is intensive and comprehensive and is significantly different from the majority of MTM models currently provided by Medicare Part D plans.
Conclusion: A referral-based MTM clinic managed by pharmacists at a university medical center outpatient pharmacy provides care to patients with the goal of improving medication access, medication adherence, continuity of care, medication therapy management, and patient education.
In the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, a small but significant provision titled Medication Therapy Management (MTM) programs (Section 1860D-4[c] [1] [2]) has created considerable interest within the health care community, particularly in the profession of pharmacy. The provision states that MTM is a service for Medicare beneficiaries who have multiple chronic diseases, are taking multiple drugs covered under the MMA, and are likely to incur an annual cost (set by the Centers for Medicare and Medicaid Services [CMS]) of at least $4000. The MMA identifies three key elements of an MTM program: (1) provision of education and counseling to enrollees to improve their understanding of their medications, (2) improved adherence to medication, and (3) detection of adverse drug events (ADEs) and patterns of prescription drug overuse and underuse. In the final rulings on the MMA, CMS stated that MTM programs must evolve and become the cornerstone of the Medicare Prescription Drug Benefit.
It is unknown what model or structure of MTM will adequately provide the outcomes desired by CMS. A definition for MTM has been established by the Pharmacist Provider Coalition. Although avidly endorsed by members of the pharmacy profession, it is unknown whether the definition will be accepted by others vested in this process (e.g., providers of prescription drug plans [PDPs], insurers, government agencies, other health care disciplines). CMS stated in its final ruling on the MMA that insufficient standards and performance measures exist to support detailed specifications for MTM services or service-level requirements. Research and careful study are needed to define what MTM services and processes will achieve the desired patient care outcomes and the cost:benefit ratio they will provide to the health care system.
We describe an MTM program that has evolved over the past 10 years in the ambulatory care pharmacy at the University of Illinois Medical Center at Chicago (UIMCC).