Post on 11-Jan-2016
University of Florida College of Pharmacy
Medication Therapy Management Communication and Care Center
A Patient Care Business:
Communications That Make a
Difference
Objectives
Introduce the University of Florida Medication Therapy Management Communication and Care Center (MTMCCC)
Describe the experience and expertise of the MTMCCC Contracts, pilots, and projects Managed care Long term care Staff credentials
Discuss the MTMCCC approach and process with long term care facilities
Identify successes of MTMCCC’s services to health plans
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UF MTM Communication and Care Center
Our Self-Funded business model includes:
Multiple call center locations Gainesville (Established 2010) Lake Nona (Established 2012)
Flexible staffing
Adaptability
Continuous quality monitoring & performance improvement
Academic and research resources
Expertise and Experience Conducted over 12,000 Comprehensive Medication Reviews & 35,000
Quarterly Reviews Conducted over 300,000 live adherence calls in 2013 Projected over 600,000 live adherence calls for 2014 3
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Current Clients -MTM Since Mar. 2010, Auto-Renewal
-Adherence Improvement Services Since Aug 2012 -MTM for MEDsAD Population, 3-Year Pilot Study Since 2011-Extended for 1 additional year to 2015
-Adherence Services Since August 2013-MTM and HEDIS Measure Improvement - August 2014-MTM for UF Health Non-Tuberculosis Mycobacterial ClinicPartnership with UF Clinic - Sept. 2013-Quasi Endowment Funds Pilot Project (February-July 2014)Patient-Centric, Telephonic MTM Services Post-Discharge to Reduce Hospital ReadmissionsAdherence Improvement Services - May 2014
-Coordination of care with case management team and providers-MTM and HEDIS Measure Improvement – November 2014
Our Average Patient
65 years old
Low health literacy
Limited resources and travel
Poor care
Medical conditions: 10
Prescription medications: 15
Over-the-counter (OTC) and/or herbal medications: 5
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Our Team
Patient
Care
Clinical MTM
Pharmacists
UF Faculty
Clinical Associates
Student Pharmacis
ts
Pharmacy Residents
Technology Team
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Our Staff Expertise Pharmacists:
Managed care experience MTM certificate program Board certified ambulatory care pharmacy (BCACP) Board certified psychiatric pharmacy (BCPP) Consultant pharmacy licensure (CPh) Certified geriatric pharmacists (CGP) Pain and palliative care experience Community pharmacy experience
Licensed practical nurse (LPN)
Registered/certified pharmacy technicians (RPhT/CPhT)
Licensed community health worker collaboration (LCHW)
Case management collaboration 7
What Services Are We Providing?
MTM Services Comprehensive Medication Reviews Quarterly reviews
Adherence Services
Prescriber Outreach Services Focusing on care coordination & quality
improvement (QI)
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What is Medication Therapy Management (MTM)?
A patient-specific & individualized service Typically for higher risk population
Goal: To optimize therapeutic outcomes to improve overall patient health
Assesses all aspects of a patient’s medication-related care
In collaboration with other health care providers
Establish continuity of care
No “gold standard” practice model 9
Framework of MTM
Established by collaboration of 11 national pharmacy organizations
The Five (5) Core Elements:1. Medication Therapy Review (MTR/CMR)2. Personal Medication Record (PMR)3. Medication-related Action Plan (MAP)4. Intervention and/or Referral5. Documentation with Follow-up
American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication therapy management in Pharmacy Practice (Version 2.0). 2008. Available online at: www.accp.com/docs/positions/misc/coreelements.pdf 10
Medication Therapy Review
AKA: COMPREHENSIVE MEDICATION REVIEW (CMR) Live & Interactive In person or via tele-health
Review of all: Prescription medications Over-the-counter products Vitamins, herbals, homeopathic Anything and everything else
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Medication Therapy Review
Assess medication related problems and opportunities: Drug-drug interactions Drug-disease interactions Non-adherence issues Gaps in therapy:
Medications missing indications Indications missing medications
Duplications of therapy Adverse reactions
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Medication Therapy Review
Inappropriate dosing: Too low/too high Opioid overutilization
Inappropriate medications in the elderly (Beer’s criteria)
Immunizations
Alternative therapies Less costly medications Combination therapy
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Personalized Medication List
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Medication Action Plan
Patient action item documentation
Promotes medication and disease self management
Collaborative effort between patient and pharmacist
Written reminders
Written in patient-friendly language (4th grade reading level)
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Medication Action Plan
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Intervention and Referral
Prescriber Interventions: Potential medication related problems Medication related opportunities Patient reported concerns and issues
Referral sources: Social and economic assistance Crisis intervention Dietary needs Other providers: behavioral health, dental,
physical therapy, etc
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Intervention Example
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Documentation and Follow-Up
Record of services for: Continuity of care Follow and monitoring of outcomes Billing and reimbursement
Documentation systems: UF MTM platform
Components: Record actions and outcomes
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Our General Practice Model
Clinical Associate
outreach to patient
CMR completed
with patient via phone
Documentation Follow-Up
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Long-Term Care (LTC) Process
LTC member determined “interviewable” by obtaining MDS 3.0 scores C0500 B0700 B0800 Scores can be obtained via phone or fax.
If interviewable CMR with member
If NOT interviewable CMR with POA/Caregiver If POA or caregiver not available, attempt CMR
with nursing staff or consultant pharmacist at facility
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Clinical Focus for LTC
Disease state management
Identification of polypharmacy Prescribing cascade Detection of adverse drug reactions; medication
overuse/underuse.
Evaluation of drug interactions
Identification of high risk medications in the elderly Beer’s List medications Fall prevention
Sedative/ hypnotic initiatives
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Adherence Services
Level 1
• Program Enrollment• Live Interactive Reminder Calls
Level 2
• Assessment of Barriers with Patient-Specific Interventions
Level 3
• Interactive Follow-Up Reviews
Level 4
• Pharmacist Interventions for High-Level Needs
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Outreach Projects
Patient Safety Measures• High Risk
Medications• Diabetes Treatment
Measure
HEDIS/Care Measures• Cardiovascular Care• Diabetes Care• Osteoporosis
Management• RA Management• Antidepressant Med
Management
Other• Reducing
Hospital Readmissions
Target patient and/or prescriber to improve quality measure performance
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Outcomes From UF Projects
MEDS-AD Demonstration Project MTM services provided to MEDS-AD patients over 4 years MEDS-AD Waiver Medication Therapy Management (MTM) Program Interim
Report by FSU College of Medicine/Social Work Describes the quantitative/qualitative evaluation and preliminary findings
The gold standard of satisfaction lies in the interviews with participants themselves, it became evident to the interviewers “that the commitment on the part of the UF COP staff to patient well-being transcended the limitations of the MEDS-AD Demonstration project while maintaining the integrity of the MTM process”
Table 2: Global Evaluation of the MEDS-AD Demonstration Project
VeryPoorN(%)
PoorN(%)
FairN(%)
GoodN(%)
VeryGoodN(%)
How would you rate the overall care that you experienced with the medication program?
0(0) 0(0) 0(0) 7(33) 14(67)
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Outcomes From UF Projects
MEDS-AD Demonstration Project (continued)UF COP staff also noted as performing tasks
often defined as medical social services. Examples of these services included:
Identifying transportation services from Tampa to Orlando to aid a patient in obtaining services from the only pain specialist who accepted patients with Medicaid.
Providing information on Medicaid coverage for non-medication services such as environmental counseling for patients with diagnoses of asthma.
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Pharmacist Recommendations During Year One
Cost-Effec-tive Option
Excessive Pill Burden
Gap in Therapy
Medication Related Problem
MISC Potential Overuse
Potential Underuse
Interven-tions
8 16 22 36 7 11 39
Resolutions 5 3 4 17 1 6 14
2.57.5
12.517.522.527.532.537.542.5
Nu
mb
er
of
Inte
rven
tion
s o
r R
esolu
tion
s
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Transition of Care Pilot Program
UF Health MTM Readmission Pilot Program Provided patient-centric telephonic follow-up after
hospital discharge 314 comprehensive medication reviews performed Results: pharmacist interventions
Total interventions via facsimile = 189 Total CMRs with intervention via facsimile = 112 (35.7 %
of total CMRs completed) CMRs with 1 intervention = 65 CMRs with 2 interventions = 27 CMRs with > 2 interventions = 20
Medication list discrepancies Total number of discrepancies identified = 823 Represented 78.34% of CMRs completed 28
Items Identified During Pilot Program
UF Health MTM Readmission Pilot Program (continued)
Potential Gap in Therapy
49%
Drug- Drug Interaction
16%
Drug-Age In-teraction
3%
Drug-Disease Interaction
2%
Duplication of Therapy
3%
Excessive Med-ication Dosage
or Use3%
Excessive use of SABA2%
Lack of Efficacy1%
Adverse Event 4%
Non-Adherence7%
Dosing Dis-
crepency4%
Suboptimal Pain Regimen2%
Refill Request2%
Reduction in Pill Burden 2%
Asthma/COPD: Lack of Rescue 3%
Asthma/COPD: Lack of Controller
3%
Diabetes: Lack of ACEI/ARB
16%
Diabetes: Lack of Statin11%
Heart Failure: Lack of ACEI/ARB
4%
Heart Failure: Lack of Beta Blocker
2%Heart Failure:
Suboptimal Beta Blocker12%
Osteoporosis: Lack of An-tiresorptive
4%
Long Term Steroid Use: Lack of An-
tiresorptive10%
ACS/CAD: Lack of Beta Blocker
3%
ACS/CAD: Lack of Fast Acting Nitrate
19%
ACS/CAD: Lack of Statin
1%
A.Fib: No Antico-agulation
2%
Other Indication9%
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New Medicaid Pilot Project
Managed Medicaid Plan: November 2014 Targeted 1000 patients based on uncoordinated care criteria & other
medication related criteria Initial CMR conducted with patient
Targeted medication review (TMR) may also be done with Primary Care Physician or Behavioral Health provider
Medication Action/Treatment Plan determined then shared with provider(s) & communicated to patient
Ongoing care coordination & medication reviews with a focus on communications between prescribers/providers (integrated into case management activities)
Quarterly assessment of changes in utilization & quality measures
Will be looking at patient-care and medical cost related outcomes 30
Summary of UF’s MTM Program
Adaptability
Flexible staffing
Continues quality monitoring and performance improvement
Academic and research resources
Clinical expertise and experience
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The UF MTM Promise
Proceed with patient permission.
Be prepared for patient.
Give patient our undivided attention.
Never be interrupted.
Never interrupt the patient.
Give the patient time to think.
We will:
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Questions?
Teresa E. Roane, PharmD, BCACPClinical Assistant Professortroane@cop.ufl.edu
Daryl E. Miller, PharmDMTM and Geriatrics PGY-1 Pharmacy Residentdmiller@cop.ufl.edu