MTM System- A unique software for all MTM requirement
Medication Therapy Management (MTM) was initiated by Congress in the Medicare Modernization Act of 2003 (MMA 2003) mentioning that each Medicare Part D plan sponsor should offer an MTM program to targeted beneficiaries beginning 2006. The targeted beneficiaries include those members with multiple chronic conditions taking multiple Part D drugs and likely to incur annual costs for covered Part D drugs that exceed a predetermined level, currently $3100 annually. Apart from these targeted beneficiaries, other patients can also benefit from MTM. Recently, many plans have incorporated MTM programs as a proactive strategy to prevent medication-related complications and associated health care costs by extending the MTM benefit to people.
So, MTM can be defined as a partnership among pharmacist/physicians, patient or their representatives and other health professionals that promotes the safe and effective use of medications and helps patients achieve the targeted outcomes from medication therapy. Thus, MTM includes analytical, consultative, educational and monitoring services provided by pharmacists to help consumers get the best results from medications through enhancing consumer understanding of medication therapy, increasing consumer adherence to medications, controlling costs and preventing drug complications, conflicts, and interactions. MTM can be specially beneficial in improving Diabetes, Asthma, and Elderly Care diseases.
Some of the main requirements which a Part D sponsor must have for an MTM program are:
Ensures optimum therapeutic outcomes for targeted beneficiaries through improved medication use
Reduces the risk of adverse events
Is developed in cooperation with licensed and practicing pharmacists and physicians
Describes the resources and time required to implement the program if using outside personnel and establishes the fees for pharmacists or others
May be furnished by pharmacists or other qualified providers
May distinguish between services in ambulatory and institutional settings
Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)
So, essentially the Centers for Medicare and Medicaid Services (CMS) require each Part D Sponsor to incorporate an MTM Program into their plans' benefit structure. Annually, Sponsors must submit a MTMP description to CMS for review and approval. A CMS-approved MTMP is one of several required elements in the development of Sponsor' bids for the upcoming contract year.
We now try to look at some of the major components of MTM:
*Annual Drug Cost of the beneficiary needs to be more than $3100
**The beneficiary should be suffering from at least two chronic diseases and at least 3 Medications
In this backdrop, the challenge is to device an MTM program that can be implemented through a proper workflow and decision support software focusing the key areas such as:
To identify beneficiaries with targeted chronic disease conditions from Part D drug transaction data eligible for MTM services as per CMS criteria.
Optimize therapeutic outcomes for targeted beneficiaries through improved medication use by identifying/reporting and helping to resolving drug abuses.
Reduces the risk of adverse events by identifying potential adverse drug events, reporting them to providers involved and help to avoid adverse events.
To measure the outcome of the MTMP program on the targeted beneficiaries.
Health Technolgy analyzed the whole process to understand the practices, implications and short-falls of the MTM processes in operation and taking guidance from the CMS requirements, a new optimized process for MTM Program was designed and implemented through proprietary MTM software called MTM System. This system is intended at optimizing therapeutic outcomes thus promoting safe and effective use of medications which can lead to overall reduction in health care expenditure both for the beneficiary as well as the PDP. MTM system will not be integrated with the existing PDP Manager application and will operate as a separate web based application based on Application Service Provider model capable of supporting multiple PDPs. The backbone of the software is regular updation of drug database from renowned provider and physician measurement specifications from NCQA.
The above diagram explains the process flow of MTM system. The typical process flow is as follows:
Claims and member eligibility data of a PDP for a month is fed into the system
The claims data is processed and filtered based upon criteria set for the PDP to find out MTM eligible beneficiary
Welcome note to enrolled eligible members is sent
Members volunteering to opt out are dis-enrolled
Medication related issues such as drug interactions, drug duplications for each MTM eligible beneficiary are identified
Recommendations based on findings of the drug review are faxed to the prescribing doctors/providers.
Doctor/Provider fax responses are recorded in the system and forms part of the Quarterly targeted drug review.
Data request (Lab data/Progress Note) for beneficiaries are faxed to the doctors/providers and their responses are recorded in the system
Telephone interview conducted with patient as part of the annual Comprehensive Medication Review and information collected through interview is recorded in the system.
CMR report prepared for each beneficiary enrolled in the MTM plan based on the Quarterly Targeted Drug Review and Annual Medication review conducted.
The highlights of the service offerings include:
Algorithm driven automatic Identification of Drug conflicts like
Adverse Drug Reactions
A comprehensive one-to-one medication review to identify issues/problems in therapy/medications
Periodic Targeted drug reviews to constantly monitor drug usage and review implementation of drug conflict fixes
Regular Provider and beneficiary follow-ups to ensure constant monitoring and quality of health for the beneficiary.
Health Technolgy’s MTM system clearly helps the concerned players with its unique features which are discussed below:
Patient-Centered Approach- Patient’s well being is the primary concern. We focus on correct medication where proper dose and dosing regimen is prescribed.
Interdisciplinary, Team-Based Approach and Communication- Our system is delivered by an interdisciplinary MTM team led by a qualified pharmacist and health care professionals who have the required expertise in the specifics of the medications.
Population and Individual Patient Perspective & flexibility for Broad Application- Our system is developed for target patient populations so that services can be individually tailored and administered.
Evidence-Based Medicine- Health Technolgyincorporates the best practices predicated on rigorously applied evidence-based medicine in our MTM system.
The MTM has not gone the way it was anticipated. According to some, the future of MTM is not very promising but we are sure that with our system, we have created a stand-alone business model/platform which will achieve greater heights in the near future and the basic objective of MTM formation will thus be accomplished.