Gaps in care, non-adherence, or management of chronic conditions are a few clinical issues in all populations, but these types of clinical issues are particularly challenging in Medicare where we are seeing an ever-growing number of Medicare beneficiaries. With 10,000 people aging into Medicare every day, we are faced with a pressing challenge of improving health outcomes, so the million dollar question is “how does the industry improve overall health outcomes for our patients?” The solution is simple – maximize your Medication Therapy Management (MTM) program to drive improved health outcomes.
Aligning Incentives, Removing Silos
Traditionally we have seen each targeted problem addressed individually, but that is a flawed mentality that causes providers to work in silos. By leveraging all member encounters – providers, case managers, pharmacies – incentives are aligned and silos are removed. Considering 90% of medication changes happen outside a Comprehensive Medication Review (CMR), we know this is possible through the MTM program.
Instead of just chasing a CMR rate, broaden the focus and expand your MTM mindset. Utilize your MTM program to its maximum capacity with these recommendations:
- Create collaborative care relationship with providers: Aligning incentives with payers and providers helps create a common goal to drive better health outcomes. To achieve this, collaborative care relationships with MTM clinicians and providers can be established to work together to not only identify potential issues but to also work toward a resolution together. With team work, the patient’s potential clinical issue can be addressed in the most efficient and effective method possible and duplication of efforts is eliminated.
- Engage and coordinate with case managers: It is no secret that case managers work hard to establish trusting, valuable relationships with their patients. While MTM clinicians and case managers play different roles in a patient’s overall healthcare, there are some commonalities, such as becoming a trusted advisor for the patient. For patients who have particularly challenging situations, leveraging a case manager’s existing relationship before and after the MTM intervention will prove beneficial. The case manager may act as a conduit to introduce the MTM program and its benefits to the patient. Syncing up clinical notes after the MTM intervention will allow case managers to better understand the clinical issues discussed with the patient, as well as create an opportunity for the case manager to reinforce the recommendation made by the MTM program’s clinician.
- Partner with your network pharmacies to complete quality metric-based interventions: With the introduction of quality-based network reimbursements, network pharmacies have a new stake in the game in achieving the best health outcomes for patients. However, one challenge that limits network pharmacies in their impact is the ability to identify opportunities for clinical interventions. Data insights can be provided to the network pharmacies through the MTM program to assist the pharmacies in identifying potential opportunities. In a case such as non-adherence to a medication, a pharmacy may be able to offer several solutions for the patient to achieve adherence from medication counseling to medication refill reminders to possible medication synchronization.
Yielding Positive Health Outcomes
At Express Scripts, we strive to continuously partner with our clients to yield a positive impact on patient health outcomes with precise, real-time data at the core of our efforts. Between 2015 and 2016, we have increased the number of MTM services we deliver to clients five-fold. Case managers are more engaged than ever in the introduction and follow-up of the MTM interventions, and we’ve established a concerted effort with a large network pharmacy to improve quality metrics was born.
MTM is more than a CMR rate; MTM is the golden thread that can weave these efforts together to create a holistic, outcomes-driven approach to treating patients.
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