Comprehensive medication management (CMM) is an extremely valuable service for health plans and providers to deliver to members and patients when key elements are in place. Effective CMM requires a combination of many factors to ensure care opportunities are identified and addressed. Falling short or skipping any of these areas of focus will likely reduce the clinical impact of CMM, resulting in suboptimal outcomes, higher costs, increased risk of adverse drug events, and disengaged members and patients, among other challenges.
To assist you in maximizing the impact of your CMM program and ensure it delivers on its great promise, your program should focus on at least these five key areas.
1. Identification of who will receive comprehensive medication management
Many studies and documents have been produced around how to best identify who should receive CMM interventions, and a common conclusion is that defaulting to "high-risk" members or patients on its own is not ideal. To get to the population that will most benefit from CMM, you will also want to focus on identifying those with rising risks.
Rising risk is a more fluid way of evaluating individuals for CMM. It's not simply a matter of looking at one or two factors and having those determine whether someone is a rising risk. Rather, you will want to be looking for "triggering events" that can result in an increase in the risk of health events. Some of these events may be driven by objective data, but you will also want to consider subjective data. For example, a patient whose medical conditions correlate with a moderate risk may become a rising risk focus for your program if they have a change in home support or exacerbation of a condition that leads to decreased engagement in their care plan.
2. Social determinants of health (SDoH) barriers
Many non-clinical elements influence a patient's engagement in their care plan and, thus, the clinical outcome. Considering the increased attention on social determinants of health, coupled with the direction the Centers for Medicare & Medicaid Services is taking to drive equitable healthcare, identifying SDoH barriers and resources to help overcome those obstacles are vitally important elements for any CMM program.
But that's just the beginning. Then, working through your program or collaborating with the third-party vendor supporting your CMM efforts, take steps that will help ensure individuals actually get connected with the right resources in their community at the right time.
Many organizations are conducting SDoH assessments. That's terrific. But unless you do something with the information gathered to assist members and patients, you're just creating more documentation. Adding the likes of community health workers to your interdisciplinary team, leaning more on clinical pharmacists, and taking advantage of SDoH programs can all make a difference as you look to build out and strengthen your CMM program.
3. Medication optimization
Optimizing members' and patients' medications is one of the most important CMM services you can provide. Start by evaluating polypharmacy, taking into account an individual's prescription medications, over-the-counter (OTC) drugs, and herbals. There's a lot you can and should do with this information. You may gravitate toward increasing or decreasing dosage to achieve better optimization, but there may also be therapies the individual is not on that they could benefit from. For example, if someone with asthma is on a short-acting inhaler, make sure they're on a maintenance inhaler as well. The statin quality measures expect patients with diabetes or cardiovascular disease to be on a statin. If they are not, identify why.
Sometimes, you may need to consider discontinuing therapy. Evaluate adverse drug events and drug-drug interactions. Is the member or patient experiencing side effects likely triggered by certain combinations? If so, work to prioritize the most important medication(s) for their condition(s). If there's a medication that might be precipitating issues, is there an alternative? Could they safely have that medication deprescribed?
Consider the likes of proton pump inhibitors (PPIs). These were not intended as long-term therapies, yet we see a lot of people started on PPIs in a hospital, and they're never discontinued.
Another opportunity around medication optimization concerns an individual's pill burden. Some people may be on short-acting therapies, yet there may be long-acting alternatives available. Making this change can help improve adherence to a medication regimen by reducing the number of pills and overall medication management responsibilities.
Finally, look at maximizing insurance benefits, which was a topic I discussed in my previous column. For example, many Medicaid and Medicare plans now offer an OTC benefit that members may not be aware of or take advantage of.
4. Patient education and empowerment
An informed and engaged member or patient is one who is more likely to believe in the concept of CMM, follow recommendations, and prioritize adherence. Motivational interviewing is a valuable and important means of engaging individuals, and it's also a helpful mechanism for understanding how a person will respond to your CMM efforts, such as what they're willing and unwilling to do and potential barriers to adherence. With this information, you can personalize your education efforts accordingly, which should help an individual better understand why they're on certain medications or what is required of them to maximize the benefits of medication and regimen. When you can personalize your education, individuals tend to feel more engaged and involved in their care.
Furthermore, such empowerment helps turn members and patients into their own advocates. Patients are often under the impression that if their primary care provider (PCP) refers them to specialists, the next time the patient sees their PCP, this provider will know everything that happened during those specialist visits. As we know, that isn't always the case. When a patient turns into their own advocate, they will feel more comfortable engaging in meaningful discussions with their providers and speaking up when they have questions or concerns about their care. This can help close communication loops between providers. A good comprehensive medication management program will help turn members and patients into advocates and more active members of their care team.
5. Ongoing evaluation and improvement
A comprehensive medication management program and the member/patient plans generated through it should be treated as living documents. As such, health plans and providers will want to regularly evaluate both, review their performance, and make adjustments that can bring about improvements.
For the CMM program, this may include asking questions like:
- Is our program impacting who we wanted it to impact and in the way we hoped/intended?
- Are there changes we should make with risk stratification, and how we're identifying individuals who would benefit from CMM most?
- Are the program's resources adequate based on the member or patient population we're engaging with?
- Are there other resources that should be added or made more readily available to help support individuals in the program over the long term?
Conducting ongoing evaluations of the CMM program and member/patient plans and then acting on what you learn will better help ensure both achieve their goals.
Making the Most of Comprehensive Medication Management
CMM can be a life-changing process for members and patients, one that helps keep them healthier while reducing costs, improving satisfaction with their care experience, and making them more active participants in their care. Achieving such results requires health plans and providers to make comprehensive medication management a priority through investments in data analysis, resources, personnel, and often external support. The good news is that when the right investments are made and areas such as those discussed above are given the attention they deserve, a CMM program can deliver results that meet and often exceed expectations.
Comments: