We wholeheartedly endorse the Triple Tree Blog posting April 7th 2015 which describes that “an effective [Medication Therapy Management] MTM program can dramatically improve adherence…”.1 While pharmacists have long been personally delivering patient care services in a variety of settings, it is true as the blog states that market drivers such as the 2003 Medicare Modernization Act (MMA) which established the requirement for Medicare Plans to provide MTM services and the Centers for Medicare and Medicaid Services (CMS) Star Rating System which offers bonus payments for meeting quality metrics have taken the complexity and the outcomes of MTM programs and services to the next level.
MTM begins with a focus on improving the various dimensions of non-adherence , but it also addresses the full range of medication related problems including unnecessary and inappropriate medication use, medication over- and under-use, inappropriate dosing, drug interactions, and adverse drug events. 2,3 The two MTM case studies in the Triple Tree blog represent this nicely, showing that MTM intervention identified unnecessary duplicate therapy, revealed overuse of an acute medication and underuse of one that actually addressed the condition itself, rather than symptoms. The process also identified gaps in use of medications recommended by evidence-based guidelines and of course adherence issues.
We note that the two case studies were 37 and 54 year old patients, demonstrating that MTM can add value beyond the geriatric patient population. But, imagine the clinical impact and ROI of MTM services applied to all of our nation’s seniors over 65 years of age who use an average of 7 daily Rx medications AND an additional 6 over-the-counter preparations and herbal/supplement products. Such patients are at great risk of adverse drug events: a patient taking 7 medications has twice the risk, and patients taking eight or more medications have a quadruple risk of suffering adverse events which can lead directly to emergency department visits, hospitalizations and re-admissions.5
Joseph Gruber, RPh, CGP, FASCP: Chief Clinical Officer, ActualMeds Corporation. Past President, American Society of Consultant Pharmacists. @jgactualmeds
Triple Tree points to examples of market activity validating the MTM model. We need to build on these examples around some key concepts:
We embrace these principles and have made them part of the ActualMeds formula for meeting the ultimate goal of MTM: helping all patients to successfully engage with their care team to manage their medications, and particularly for our older adults to age in place with dignity and quality of life. Our technology enables a team-based approach and promotes pro-active, longitudinal personal engagement with patients and providers. Our managed services offer an on demand consulting pharmacist if needed. Care teams are informed first with what medications patients are actually taking, second that all medications are necessary and not harmful, and third that the regimen is designed to be as simple as possible. Armed with this information at point of care the care team has the best opportunity to engage the patient and tailor the intervention that will have the greatest impact for improving outcomes.
1 Medication Non-Adherence: A $290 Billion Unnecessary Expenditure;Triple Tree Blog April 7, 2015
2 Hepler CD, Strand L. Am J Hosp Pharm 1990;47:533-43 and Strand L. Pharm J 1997;258:899-904.
3 Medication Therapy Management in Chronically Ill Populations: Final Report. Acumen, LLC, Burlingame, CA Agusut 2013
5 ConsultPharm 2014;29:689-97