We have a bone to pick with the Centers for Disease Control and Prevention (CDC). The CDC states the following: "Medication therapy management (MTM) is a distinct service or group of services provided by health care providers, including pharmacists, to ensure the best therapeutic outcomes for patients." Our issue with how CDC defines MTM here is the claim that medication therapy management ensures the best therapeutic outcomes. While MTM can help improve outcomes, we believe it also can come up short on delivering the best outcomes for patients. Such optimized outcomes will only come through the usage of enhanced medication services, such as those delivered via comprehensive medication management (CMM) and technology-enabled CMM.
Below, we will discuss some of the key elements of enhanced medication services. But let's step back a moment and take a closer look at MTM and its core components so we can have a better understanding of how enhanced medication services essentially takes MTM to a whole new level.
Understanding MTM: Meaning of Medication Therapy Management
As a Journal of Managed Care & Specialty Pharmacy article notes, while medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, pharmacists have provided similar services since the term "pharmaceutical care" was introduced in 1990. The article states that integrated healthcare system Fairview Health Services implemented a standardized pharmaceutical care service system in the late 1990s — one that it later named a pharmaceutical care-based MTM practice in 2006.
When providers, payers, and other organizations speak about medication therapy management, they are typically referring to one of two concepts. There's MTM, meaning the service or group of services as noted in the aforementioned CDC definition. When used in this manner, medication therapy management typically includes the following five core elements: medication therapy review (MTR), personal medication record, medication-related action plan (MAP), intervention or referral, and documentation and follow-up.
Then there's MTM meaning a specific program included in the Medicare Part D benefit. As a different Journal of Managed Care & Specialty Pharmacy article notes, "… the Centers for Medicare & Medicaid Services (CMS) have established minimum requirements for health plans to follow in establishing patient eligibility for enrollment in these programs. The eligibility criteria are based on projected annual Part D medication costs, number of chronic disease states, and number of chronic Part D covered medications."
Getting back to the five core elements of MTM, these essentially boil down to performing a baseline medication review and then using the information that's derived from it develop a plan (MAP) for patients. This plan is intended to help patients achieve the best results from following their medication regimen.
While the intention behind medication therapy management is noble, the sole focus on a patient's existing medications as the baseline for delivering interventions is not likely to achieve the "best therapeutic outcomes" claim associated with MTM. For most patients, that can only come about through leveraging enhanced medication services.
4 Enhanced Medication Services to Know
There are several enhanced medication services that providers will want to consider for their patients if the goal for patient care is to achieve optimized outcomes. Here are some of the most important enhanced medication services to know about, all of which are typically facets of comprehensive medication management.
1. Medication reconciliation
There are good reasons why we refer to medication reconciliation (i.e., med rec) as the "key patient safety issue for healthcare providers." Medication reconciliation, when performed correctly and completely, will help find and resolve medication discrepancies that can adversely affect patient outcomes. Comparing the medications a patient is currently taking or should be taking as per clinician orders with newly ordered medications should help identify issues of concern such as omissions, potentially harmful interactions, duplications of medications, and the need to continue current medications.
If a medication review is performed and action plan developed without completing medication reconciliation in conjunction, the plan could include medications, dosages, and/or frequencies that will cause more harm than good.
Effective medication reconciliation supports efforts to deprescribe. As Deprescribing.org states, "Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit." Deprescribing has several worthwhile goals, including:
- Reducing medication burden
- Reducing the risks associated with polypharmacy
- Increasing patient engagement
- Decreasing patient costs
While deprescribing as a concept has been around for a few decades, it's getting increased attention these days as the number of patients taking five or more medications — which is typically how polypharmacy is defined — has grown significantly in recent years. If you're not familiar with deprescribing, we recommend reading this blog that provides a good overview.
3. Condition-specific medication management
Most patients with a chronic condition rely upon one or more medications to help with ongoing disease management. Effective medication management — and an essential enhanced medication service — should take into consideration a patient's specific conditions and the medication(s) that will best support short- and long-term quality of life goals.
As an extension of condition-specific medication management, when a new medication is introduced to a regimen, patients and providers should closely collaborate to ensure the new medication helps accomplish its objectives by monitoring results and side effects and adjusting dosage and frequency, when necessary. At the same time, this monitoring must ensure that the change to the medication regimen is not contraindicated by a patient's condition(s) and supporting medications.
By providing patients with information and education about the role medications play in chronic condition management, this will increase the likelihood of medication adherence and successful outcomes.
4. Medication adherence
What good is a medication plan if a patient doesn't follow it? Not much. That's why efforts around improving medication management must include a medication adherence component.
In "Medication Adherence: A Comprehensive Guide for Providers," we take a deep dive into the importance of medication adherence and what providers can do to overcome the impediments to successful adherence. Among the best practices we highlight:
- Focus on the risks of non-adherence
- Review potential side effects
- Give patients a response plan when confronted with adherence concerns
- Discuss the ability for a patient to pay for their medications
- Recommend tools and resources that can help with adherence
Appreciating the Value of Enhanced Medication Services
As you can see, providing enhanced medication services does just what its name suggests: enhances medication services for patients. With comprehensive medication management, which includes all these services and others and must be provided by a residency-trained clinical pharmacist, organizations can better ensure that they provide the "best therapeutic outcomes for patients" in addition to helping patients save money and avoiding readmissions and other undesired treatment outcomes.
Tech and data enabled comprehensive medication management goes even further by supporting enhanced medication services with technology. For example, our CMM service brings together all of the missing variables that once made optimal medication management an unattainable reality. Comprehensive, reliable, real-time medication histories with clinical context, cutting edge technology that makes sense of this data, and expert patient outreach and engagement that actually reaches the patient and builds positive relationships, all resulting in the best medication action plan specific to each patient that they, and their providers, can trust.
To learn more about the service, schedule a call with one of our specialists.