In the past two blogs we’ve looked at why medication therapy management (MTM) is important for evolving care management and delivery models such as accountable care organizations and patient-centered medical homes, and how MTM presents a real opportunity for health plans. So let’s assume that readers understand those two points and are interested in actually instituting an MTM program. What exactly is involved?

Well, in a word, technology. It’s essential to have the proper systems in place that can perform the specific tasks and procedures necessary for an effective MTM program. Unfortunately, most of today’s provider systems don’t offer the population-based analytics needed for MTM, nor do they have the care coordination tools to manage members and their medications as they move across the continuum of care. For this reason, it’s helpful to take a very close look at the exact requirements for MTM solutions.

Essentially, the technology to support an MTM program should be comprised of three main components.

The first is a comprehensive medication list within a member’s clinical record summary. It is comprehensive in the sense that it aggregates all prescriptions that come through the health plan, regardless of where they originated, which is something that electronic medical record systems and pharmacies cannot do today. This will include the member’s medication possession ratio, decided through analytics, which identifies under-utilization of medication therapy, and the ability for the care manager to add member-reported medications. These are an important piece of the puzzle, as over-the-counter herbal supplements, for example, can interfere with medication such as chemotherapy.

The second component is population-based analytics and reporting for measuring and managing medication therapy programs using claims, pharmacy, HIE and lab data, including:

• Generic/formulary versus brand equivalents. Health plans and ACOs can use analytics to help optimize generic utilization.

• Polypharmacy. Health plans and ACOs can easily identify patients on multiple medications.

• Adverse drug events. Analytics applied to claims, pharmacy and clinical observational data (such as vital signs and lab data against the member’s medication profile) can help prevent the 1.5 million adverse events that are caused by medication errors each year.

• Drug therapy efficacy. Analytics applied to longitudinal health plan data can help determine the efficacy of drug therapy programs by identifying dosage problems, duplicate therapies or the need for additional drug therapy.

• Medication Adherence. Analytics can be used to provide information about populations in general, and at the provider and member levels to help identify and manage adherence issues.

The last IT component of an MTM program is provider-based care management tools. In addition to the comprehensive medication list, care coordinators or managers within a medical home need certain other core resources, such as:

• Medication therapy review. This provides the ability to assess medication therapies to identify medication-related problems and create a plan to resolve them.

• Medication-related plan. The ability to:

○ Incorporate medication therapy information into a patient’s plan of care in order to optimize their treatment plan and overall health.

○ Document pharmacy or provider consults.

○ Support the pharmacist’s plan of care for values that they may manage.

• Personal medication record. This includes a comprehensive record of the patient’s medications, including member-reported over-the-counter medications, herbal products and dietary supplements.

Over the course of our 20-plus years in the industry, MEDecision has forged a reputation for being at the forefront of innovation to support healthcare’s changing needs. The ACO, PCMH and MTM trends are no different. In the next blog we’ll take a look at how our technologies can help health plans deliver successful MTM programs and capitalize on the various benefits they stand to offer.