A few key reasons:
1. Payers remain concerned about opening a "blank check" for cognitive services without understanding the value
2. Very difficult for pharmacies to alter prescription workflow to provide intensive management for just a few patients
3. Cumbersome process to get started including new training, contracting and billing requirements
I have tried the following process with limited success but still believe it is the best way to get pharmacists engaged in medication therapy management.
1. Use an alert engine to identify and notify the physicians about drug therapy issues (e.g., poor adherence)
2. Refer select high-risk alerts and those without a successful change in therapy to care managers; including pharmacists for medication therapy management (MTM)
3. Two options for paying pharmacists to manage medication therapy; a) pay the local pharmacist to address the care gap and document their intervention or b) contract with pharmacist MTM firms to intervene telephonically
This process helps control budget concerns by only paying for carefully identified, high risk drug therapy issues. It also eliminates the need for cumbersome training and contracting issues.
Here's a few highlights from the August 15th AJHP News article "Wyoming Pharmacist Consultation Program Ends, but Idea Survives Elsewhere" http://tinyurl.com/map5o7
Wyoming's program, recently cut, pays up to $120 for a one-time consultation but enrolled only 15-20 patients annually. Medicare Part D prescription drug benefit went into effect. Montana pays up to $125 and has 19 participating pharmacists but only four patients with a fully documented session. Colorado pays $75 per session but the article did not mention the number of participants. Though open to any state resident, part of the low participation relates to the introduction of Medicare Part D that lowered costs for patients over age 65. This reduces the demand for counseling focused on cost savings.
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3 comments:
Great comments. Check this out for help starting MTMS. I Like your triage ideas. Once a patient is ID’d as a condidate for MTMS and expresses interest, I suggest asking them to register their history, assure privacy, give free thumbnail assessment including your thoughts on potential outcome (well-being and financial). Then provide the care as a totally separate function - sitting down in private space and billing under separate practice name.
http://www.pillhelp.com/press/
Don Thibodeau, PharmD
Do you happen to know if the PillHelp system can upload data into other care management systems (e.g., TriZetto)? Pharmacists could obtain a lot of useful information (e.g., HRAs) for disease management programs and even help with referrals. We need to find easy ways to share the data.
PillHelp is built on architecture that is very flexible. We are waiting to see what the standards will be for electronic records. Our goal is to dovetail to and from those data sources. In the mean tme, we should be providing care. Hard for us to expect consumers and insurers to buy MTM when they have not seen in action. As one of my physician referral sources told me, "if we knew that this (my PillHelp Works consult) was what MTMS is, it would be mainstream in no time."
To address the original point concerning cumbersome set up, etc. - PillHelp Works absolutely solces that problem.
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