Managed care pharmacy residents engage directly with patients through Medication Therapy Management

December 21, 2015

Medication Therapy Management (MTM) is helping UMass Medical School’s Clinical Pharmacy Services’ managed care pharmacy residents learn how to make medication information more understandable for patients, and to hone their motivational interviewing and listening skills.

“When patients constantly hear that they’re not doing enough to manage their conditions, it can be upsetting. The MTM program allows us to encourage and empower patients and congratulate them on their efforts, which isn’t always what they’re hearing from their friends and family or their caregivers,” said Briana Santaniello, PharmD, MBA, a managed care pharmacy resident.

MTM is a direct conversation between a pharmacist and patient about all the patient’s medications in conjunction with the medical conditions. This patient-focused, telephonic outreach approach may lead to better health outcomes for patients, who often have complex medical conditions and medication regimens.

The goals of MTM are to improve medication adherence, detect adverse events or medication misuse, provide education, and assist the patient in developing personal strategies to achieve the outcomes they are striving to reach. MTM differs from other types of patient counseling because of the scope of the conversation and its function as a two-way discussion.

“MTM allows managed care pharmacists to play an important role for a large population of patients. During MTM encounters, we are given the opportunity to be a patient’s medication expert, clarify medication-related concerns, orchestrate medications from multiple providers, and report to the rest of the patient’s team, through the primary care physician or care manager, any suggestions for improving medication therapy,” said Stephanie Tran, PharmD, a managed care pharmacy resident.

MTM has been practiced since the 1990s and was legislatively recognized with the Medicare Modernization Act of 2003, which required that Medicare Part D insurers provide MTM services to selected members. MTM was incorporated by the Centers for Medicare & Medicaid Services as a measure for Medicare Star Ratings in 2016.

The national focus on MTM will continue to grow and Clinical Pharmacy Services’ residents will be well-positioned to play a role in the evolution of these services over time, said Bonnie Greenwood, PharmD, BCPS, clinical program director. The residency program provides managed care pharmacists with the skills they need to meet future demand.

The Clinical Pharmacy Services’ managed care MTM program allows a view of “the big picture” because it gives pharmacists access to office notes, hospitalization dates and medication adherence that pharmacists in the retail setting do not have, Santaniello said.

“This allows us to evaluate the impact of medication nonadherence on each patient’s outcomes, identify potentially problematic areas, provide education and propose interventions,” Santaniello said. “MTM certainly has the ability to close the loop on medication-related issues and ensure that the member achieves the greatest outcomes from his or her current therapy.”

Santaniello recalled one call in which she helped a patient with an advanced form of cancer save money. The woman was unaware of some benefits provided by her health insurance plan and Santaniello’s recommendations had the potential to substantially cut the woman’s monthly out-of-pocket expenses.

Tran finds making a recommendation that “clicks” with a patient particularly rewarding. She addressed a patient’s maintenance inhaler use, even though the pharmacy claims showed she was adherent with her medications. The patient was taking two inhalations of the maintenance inhaler once daily instead of the prescribed one inhalation twice daily. The woman immediately realized she likely wouldn’t need to use her rescue inhaler as often if she used her maintenance inhaler as prescribed.

“We have the unique opportunity to view individual member’s pharmacy claims so we can address nonadherence, and because we have telephonic rather than face-to-face encounters, we counsel patients when it is convenient for them and in the comforts of their home,” Tran said.

Clinical Pharmacy Services provides a comprehensive range of pharmacy management programs, and has experience building customized MTM services for clients and performing MTM services for Medicare and dually eligible Medicare-Medicaid patients. The program’s more than 60 clinical pharmacists have expertise in many clinical topics, including diabetes, dyslipidemia, congestive heart failure, hepatitis C, hypertension, mental health, migraine management, opioid management, post-myocardial infarction care, and respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD).

“I chose (the Clinical Pharmacy Services residency program) because of its in-depth rotations in the major areas of managed care and its emphasis on professional development,” Tran said.

Santaniello learned about Clinical Pharmacy Services while researching managed care residency programs. “I was amazed at how (Clinical Pharmacy Services) always seemed to be two steps ahead of everyone else and I knew I wanted to become part of this high-level team,” she said.

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