Brian Litten Outlines Challenges With Adopting Medication Therapy Management Services

Brian Litten, JD, chief strategic officer, Tabula Rasa HealthCare, discusses how Medication Therapy Management (MTM) services work to improve health outcomes, challenges with the adoption of MTM services, and how CMMI's Enhanced MTM Model addresses these challenges.

Transcript

How do Medication Therapy Management services work to improve health outcomes? Are there any challenges with the adoption of these services?

Medication Therapy Management (MTM) is a suite of clinical services provided by a pharmacist to help doctors and patients with their medication regimens—to optimize the safety of their medications and have better outcomes.

So, there are 3 components of MTM. One identification, one is engagement, and one is intervention. The identification phase is where a health plan, primarily a payer, will identify a cohort of patients who they believe—or in the case of Part D the government believes—will benefit most from MTM services. The identification part is the easy part. The second part is engagement. That’s a little bit more tricky. In the engagement phase, MTM providers, vendors, need to work to establish trusted relationships with patients and with doctors. Doctors have very busy workflows and significant demands upon them. Patients tend to be cynical about strangers calling them to talk about health issues. So that’s a big challenge.

On the intervention side, once you get that trust and you’re able to have that success of gaining the patient’s and doctor’s trust, having a real conversation about the risks that have been identified and the steps that can be taken to reduce the risk provide results.

Another significant challenge is that, historically, since Part D adopted MTM as a requirement back in the Medicare Modernization Act of 2003, it has become, overtime, just a process driven event. It’s measured in terms of completion rates—how many patients are eligible for MTM services and out of those patients, how many of them have had a Comprehensive Medication Review. Plans are measured on process, rather than on quality, and that’s where the whole purpose of MTM really has been lost.

How does CMMI’s Enhanced Medication Therapy Management Model address these challenges?

The enhanced MTM model is a recognition on the part of the government that traditional MTM, which is process driven, doesn’t provide adequate incentives to health plans to really do what MTM is supposed to do, which is drive better results. So, in the enhanced MTM program, the government has removed—for those plans participating in the 5-year model—the regulatory requirements, the completion rates, all of the administrative burdens that have grown up around MTM in the Part D space, and they’ve charged the plans to innovate.

They’ve said, quite specifically, be as creative as you can be, and figure out how to make this work. What work means is to use MTM, the suite of services that pharmacists provide to doctors and patients, to have an impact on therapeutic outcomes. They’ll be measured, instead of on completion rates, instead of on process, they’ll be measured on reducing actual medical expenditures. The success of the program will be determined on their ability to do that.