Improving Health, Reducing Costs With an MTM Program

Although Rhode Island is the smallest state in the United States, it had the fourth highest healthcare spend, which meant the state was spending “way too much” on healthcare, according to Beth Hebert-Silvia, RPh, managing director and assistant vice president of pharmacy at Blue Cross and Blue Shield of Rhode Island (BCBSRI).

At the Academy of Managed Care Pharmacy’s 27th Annual Meeting & Expo in San Diego, April 7-10, Ms Hebert-Silvia described the medication therapy management (MTM) model BCBSRI implemented with the help of OutcomesMTM.

The patient-centered medical home (PCMH) has proven to be the model that works the best in Rhode Island, she said. Looking ahead to what is needed to meet 2018 goals, the 3 keys to the success of the PCMH are: population health management, provider reimbursement, and analytics and reporting.

BCBSRI has struggled in the MTM space, Ms Herbert-Silvia admitted. It teamed with OutcomesMTM to help with the deployment of pharmacists, and the company enrolled all of its Medicare beneficiaries plus its commercial members who were older than 60 years of age. The membership was split into PCMH and network pharmacies.

“We all as health plans have the triple aim,” she said. “We want to decrease health care expenditures, we want to increase the member experience, and we want to increase our healthcare outcomes.”

Over 6 months that the MTM model was employed, BCBSRI realized $1.48 million through medical and pharmacy cost avoidance. Of the 48,403 Medicare members eligible, the model served 5092 for a total of 9313 MTM claims and 1456 claims for drug therapy problem resolutions. The engagement rate was 55% overall.

For its commercial members, engagement was lower at 41%, and BCBSRI realized $571,857 in savings.

The overall return on investment in the PCMH was $8.76 for every dollar spent and $6.61 for every dollar spent in the network model, Ms Herbert-Silvia reported.