By Katherine Capps, Co-Founder and Executive Director, GTMRx Institute
Twitter: @GTMRxInstitute
Employers want a better health care system. They want to decrease waste and ensure that their employees have access to effective, efficient, high-value care.
They are focusing on managing chronic conditions and medication costs, and rightly so. Nearly 75% of primary care visits involve medication prescribing.¹ It’s how we treat and manage most conditions. But we still haven’t managed to get the medications right.
Ninety percent of employers surveyed identified drug prices as the greatest threats to affordability of employer-provided health coverage. The survey, released by the National Alliance of Healthcare Purchaser Coalitions in September 2020², also found that the most common employer strategy to address affordability is medication therapy management (MTM), used by 49% of those surveyed. Another 18% are considering MTM over the next two years.
Nearly a quarter of the employers surveyed (22%) want more information on MTM. That’s understandable, because there’s not a lot of clarity around what services MTM entails.
Moving from MTM to CMM
MTM is a broad, often amorphous, term that has, over the years, come to include all sorts of activities aimed at optimizing medication use. It is not clearly defined or implemented in a standard way. Moreover, most MTM efforts typically focus on adherence to a medication for a specific condition—but programs are not designed in a comprehensive way—one that would take into consideration all medications being used, along with the needs, beliefs, expectations and clinical status of the patient.
To eliminate waste, and obtain value, employers as health plan sponsors should demand a more sophisticated type of MTM: comprehensive medication management (CMM).
CMM basics
CMM is a patient-centered approach to optimizing medication use and improving patient health outcomes. I could go on about what makes it different, but it largely comes down to this: the reliance on a care process. A clinical pharmacist, in collaborative practice with a physician, delivers this process, working in partnership with the patient and other health team members.
It begins with identifying patients that have not achieved clinical goals of therapy, then ensures each patient’s medications (be they prescription, nonprescription, alternative, traditional, vitamins, nutritional supplements or something else) are individually assessed.
This assessment, generally performed by the clinical pharmacist on the team, determines whether each medication has an appropriate indication, is effective for the medical condition and achieving defined patient and/or clinical goals, is safe given the comorbidities and other medications being taken and that the patient is able to take the medication as intended.
Once a determination is made that the medication is safe, effective and appropriate (sometimes with use of diagnostics tools such as pharmacogenomics), the patient’s ability to adhere to the prescribed regimen is considered.
A word about adherence
Today, many MTM programs start with adherence and end with blaming the “non-compliant” patient for lack of results. While ensuring adherence is important, it’s far from the leading barrier to optimizing medication use. In fact, it accounts for less than 15% of the medication therapy problems.³
To focus only on adherence is misguided and dangerous. If you are “compliant” and adhering to the wrong medication, it could kill you!
Achieving value from what you spend on drugs is much more complicated, requires integration with a well-defined process of care, and it is comprehensive.
Sourcing programs that are comprehensive
CMM is the robust choice for employers and health plans serious about impacting the bottom line. It provides a more whole-health, whole-person approach to medication management, including an assessment of the patient’s clinical status to be evaluated in conjunction with the patient’s medications and health conditions. But finding solution providers that will work with you to offer these programs is not always easy.
That is why leveraging your buying clout matters.
We aren’t just talking about vague concepts here. We know CMM works. We’ve compiled the evidence.4 We have identified use cases. And to further transform practice and care delivery, we will soon release an employer toolkit collaboratively designed with some of the nation’s most active employer coalitions.
Begin today to work with your MTM solution providers. Through your contract authority urge them to deliver a more sophisticated, effective way to get the medications right.
Employers can make this happen. You have the leverage. We have the tools. Let’s get this done!
See original article for all references. This article was originally published on the GTMRx Institute blog and is republished here with permission.
Tune In to Voices of Change Podcast
We see it every day; needless lives lost and wasted money from the current trial and error approach to medication use. In fact, 275,000 or more lives are lost and at least $528 billion dollars are wasted yearly due to non-optimized medication use. The good news is there are opportunities to control the loss and waste, whether you are involved in receiving, paying for, or delivering care. Living in a world where patients get the right medications, the first time is attainable – and it doesn’t have to take decades to create this world.
Hosted by the GTMRx Institute’s Executive Director and Co-founder, Katie Capps, Voices of Change will feature leaders who have knowledge, experience and ideas to solve this urgent need to getting the medications right.