Experiences in Innovation: Enhanced Medication Therapy Management

This article was written by Lauren Steffen, PharmD, BCGP, Director, Education & Training, Tabula Rasa HealthCare (TRHC).

TRHC has been involved in the Part D - Enhanced Medication Therapy Management (EMTM) pilot project with the Center for Medicare and Medicaid Innovation (CMMI) since 2016. With an overall goal to improve the quality of care while also reducing costs, each accepted proposal has a unique design.

As part of the program design with which TRHC is involved, TRHC pharmacists headquartered in Moorestown, New Jersey, work with healthcare professionals in the CMS Region 25, which includes Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming.

Over the past 2 years, we have had the opportunity to interact with and support the healthcare team, both remotely and in person, to improve medication safety for Medicare participants in this region. In general, we have worked to implement technology that helps identify risks of adverse outcomes on both a population level and an individual member level to enable the healthcare team to intervene and minimize risks associated with a given medication regimen. In order to implement a patient safety initiative most effectively, we have been involved in collaborative education—both providing education to healthcare providers in the area and gleaning insights from healthcare providers to identify potential areas of opportunity and growth.

Our EMTM project includes a pharmacist-led medication safety review based on TRHC’s proprietary Medication Decision Support tools. The pharmacist can use these risk identification tools to guide discussions with the member and inquire about potential adverse effects due to a variety of intrinsic medication factors. This evaluation is contingent upon a successful medication reconciliation, which considers the prescription medications, over-the-counter medications, and supplements a patient is taking and how the patient is administering each product. Many drug interactions can be mitigated by separating times of administration, so this last detail cannot be overlooked.

Once the pharmacist has created a plan, including interventions that are realistic based on the member’s situation, the pharmacist forwards the recommendations to prescribers for review and implementation. There is immense opportunity for interprofessional practice and capitalizing on each team member’s proficiencies throughout this pilot program. Since there is this potential for great synergy among healthcare professionals, we need to ensure all team members are equipped with the same scientific knowledge and understanding to realize the value and implications of interventions.

We have solicited input regarding familiarity with medication-related risks, including multi-drug interactions and opioids specifically, from healthcare providers in the project area. We have found that, similar to other areas and practice settings throughout the United States, there are varying degrees of familiarity with the role of drug metabolism in influencing drug interactions. This lends credence to additional education in the realm of multi-drug interactions and utilization of Medication Decision Support Systems.

A consistently salient point was the value prescribers saw in pharmacists being a safety net to check for potential drug interactions, as well as to appropriately evaluate and intervene regarding risks associated with a member’s medication regimen. While prescribers appreciate the science behind Medication Decision Support Systems for multi-drug interactions, pharmacists may be best positioned to take on the assignment of continuous, thorough assessment of medication-related risks. Working as part of a team, prescribers and pharmacists can optimize patient outcomes in the economic, clinical, and humanistic domains.

Through the past year, we have had the fortunate opportunity to work directly with many community pharmacists in Region 25. We have provided education on our Medication Decision Support Tools that can be implemented in established practices to improve patient safety. This well-respected patient relationship affords the community pharmacist the opportunity to connect on a personal level and hear the details that may reveal an adverse event caused by a medication or combination of medications. Stories abound of how highly pharmacists are regarded, by both their patients and the healthcare professionals in their communities. Building a strong relationship certainly helps keep the communication open for explaining rationales behind a specific recommendation and even creating a follow-up plan after changes are implemented.

In the end, it is essential to keep members in an active role within their healthcare team. In speaking directly with members, TRHC and Region 25 pharmacists have heard great success stories of symptom improvement after ameliorating multi-drug interactions. In the end, by making the patient primary, we hope to show the real and perceived benefit of the EMTM pilot program.