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What Is MTM: Understanding Medication Therapy Management and Its Flaws

ways to increase medication compliance

If you've come to this blog to get an answer to the question, "What is medication therapy management?" (i.e., What is MTM?), then keep reading. We'll spend some time defining and examining the concept. However, if you're looking to learn why your organization should implement a medication therapy management service, you've come to the wrong place.

While MTM has value as a service, healthcare providers looking to achieve the most substantial improvement in patient outcomes would be better served by implementing another service: comprehensive medication management (CMM), and more specifically technology-enabled CMM.

Once we gain a better understanding of MTM, we'll take a closer look at why CMM is a more valuable services for providers and patients and how technology can further elevate the value and performance of CMM.

What is Medication Therapy Management: Defining MTM 

So, what is MTM? Let's look at how some organizations and publications define medication therapy management.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) describes medication therapy management as "a program of drug therapy management that may be furnished by a pharmacist and that is designed to assure, with respect to targeted beneficiaries ... that covered part D drugs under the prescription drug plan are appropriately used to optimize therapeutic outcomes through improved medication use, and to reduce the risk of adverse events, including adverse drug interactions."

The CDC's Division for Heart Disease and Stroke Prevention states, "Medication therapy management (MTM) is a distinct service or group of services provided by healthcare providers, including pharmacists, to ensure the best therapeutic outcomes for patients."

From the aptly titled "Definition of Medication Therapy Management: Development of Professionwide Consensus" article in the Journal of the American Pharmacists Association, the definition is as follows: "MTM is a distinct service or group of services that optimize therapeutic outcomes for individual patients. MTM services are independent of, but can occur in conjunction with, the provision of a medication product.

Something that's important to note when discussing and defining MTM is that the concept can pertain to a specific program that's included in the Medicare Part D benefit. CMS.gov notes that Part D sponsors must have an established Medication Therapy Management Program, sometimes referred to as "MTMP" or MTM Program, that meets a number of requirements and is incorporated into their plans' benefit structure.

The Core Components of Medication Therapy Management

Generally speaking, medication therapy management includes five core elements:

  1. Medication therapy review (MTR)
  2. Personal medication record
  3. Medication-related action plan (MAP)
  4. Intervention or referral
  5. Documentation and follow-up

To elaborate further, MTM typically begins with a "comprehensive medication review" (CMR). What is a comprehensive medication review? The book, "Medication Therapy Management: A Comprehensive Approach," defines it as follows: "The CMR involves an interactive face-to-face or telehealth medication review and is a systematic process of collecting patient-specific data, assessing medication therapies to identify medication-related problems, prioritizing a list of medication-related problems, and creating a plan to resolve them with the patient, caregiver, and prescriber."

Following this review, the patient is supposed to receive a plan outlining what they should do to get the most beneficial results from their medications. This is the medication-related action plan (MAP). The CMR is then likely to be followed by three sessions where a clinician engages with a patient to review the current list of prescriptions and identify potential problems and opportunities for improvement.

The Problems With Medication Therapy Management

On the surface, medication therapy management may seem like a good service to offer and provide to patients. But once you dig a little deeper, flaws begin to emerge.

MTM is essentially a medication-focused approach to optimizing a patient's drug therapy and regimen. In even simpler terms, it's the process of looking at a list of medications and assessing its accuracy and appropriateness for the condition(s) being treated. Where this process comes up short is in its narrow focus on medications as the baseline for interventions. In fact, there are many other factors that should be taken into consideration when working to optimize and make changes to a medication regimen — factors that will be discussed below.

Furthermore, MTM can be provided by retail pharmacists. While these pharmacists play critical roles in supporting patients, they typically lack the clinical context necessary to effectively and accurately assess whether a medication and its dosage is appropriate for a patient given their underlying condition(s) and clinical course.

There's also debate about whether MTM is truly effective in accomplishing its primary objectives of ensuring the "best therapeutic outcomes for patients." Any shortcomings associated with MTM that contribute to suboptimal medication management can lead to an increased likelihood of readmissions, adverse drug events, and other complications.

Fortunately, there's what could be considered a better form of MTM that providers can implement: comprehensive medication management.

Comprehensive Medication Management: A More Effective Way to Help Patients

What is comprehensive medication management? We like this explanation from an American Association of Colleges of Pharmacy article: "CMM is a patient-centered approach to optimizing medication use and improving patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other healthcare providers."

Like medication therapy management, the initial interaction between patient and clinical pharmacist is a comprehensive medication review. What follows is a cadence of usually monthly, more targeted follow-up sessions focused on making ad hoc interventions based on observations by the clinical pharmacist.

Let's unpack this further to show a few of the important ways CMM differs from MTM. First, let's examine the phrase "patient-centered approach." Comprehensive medication management factors in how a patient's health condition, including lifestyle, comorbidities, potential barriers to medication adherence, and other issues, may impact medication therapy. CMM also involves assessment of the full patient medical record, including lab and test results, clinician notes, and other essential information and data. Why is this important? All these details should be taken into consideration to better ensure changes to a medication regimen are safe, appropriate, and will keep a treatment plan on the best path for success.

Making changes based solely on a patient's medications and conditions, as is the case for medication therapy management, can easily lead to an oversight of one or more important factors that should be taken into consideration before proceeding with changes. It's no wonder that avoidable illness and death resulting from non-optimized medication therapy costs more than $500 billion.

Patients also benefit from CMM because it is "delivered by a clinical pharmacist." Comprehensive medication management, by its definition, must be performed by residency-trained clinical pharmacists. This brings with it another level of expertise and experience that can help further optimize a medication regimen. When a clinical pharmacist has all the information gathered as part of the CMM process, they are also in a better position to question and assess the accuracy of a medication list rather than working off of a list assumed to be correct.

There are many more benefits of comprehensive medication management, some of which are discussed in this Cureatr blog. When performed consistently and appropriately, CMM delivers more optimized medication therapy, reducing readmissions and other avoidable, poor treatment outcomes. To learn more about how MTM and CMM differ, read this blog.

Tech-Enabled Comprehensive Medication Management: An Even Better Way

Organizations looking to deliver stronger care and further maximize the benefits of comprehensive medication management can now pair the CMM process with supporting technology, i.e., technology-enabled comprehensive medication management. Cureatr's CMM service powered by Meds 360° works as an extension of an organization's care team. How does this work? Cureatr clinical pharmacists virtually assess patients, evaluate medication care plans, and enable real-time monitoring of medication-taking behavior.

The pharmacists also benefit from clinical event notification technology, which informs them when a patient under their supervision experiences a healthcare event, such as an emergency room visit, annual wellness visit, or surgical procedure, that could lead to changes to a medication regimen (e.g., new prescription) or discovery of a new condition that could affect existing medication therapies. All this information about patients, their medications, and the factors that can impact therapy enables healthcare providers to respond quickly when medication changes or non-adherence may lead to patient harm. 

To learn more about Cureatr's innovative, tech-enable comprehensive medication management service, schedule a time to speak with one of our specialists.

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