Medication use impact reviewed

December 21, 2009
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A pilot program underway at four MMPC sites is testing the viability of medication therapy management in doctors’ offices.

After six months, the 18-month trial program — which includes partners Priority Health and Well Street Care Management — is so far drawing good reviews from the viewpoints of patients and doctors, said pharmacist Sandra Chase.

“I can spend time with them, answer their questions, help them understand and help them get things paid for,” Chase said.

Anton Sheridan, business development manager for Well Street, a subsidiary of the Michigan Pharmacists Association, said medication therapy management has the potential to reduce drug costs along with improving care for patients.

“(Medication therapy management) is pharmacists taking responsibility for the drug therapy of a patient, managing it so it’s safe and effective, making sure the patient is getting the right medication for the right disease and getting the right amount of medication, and evaluating where they are with the care plan,” he said.

“The process of engaging pharmacists in managing drug therapy for a patient is not a new idea,” he added. “My take on this is that medication costs have increased, medical costs have increased, and we’re at the point — with the introduction of Medicare Part D — to look at better ways to manage medicine to help us contain the health care bill.”

Chase said that while better patient care is the main goal, medication management therapy has the potential to decrease health care costs. For example, she found a patient who was taking four blood pressure medications at “piddling” doses. Chase suggested the physician realign the medication so that the patient could take two medications at higher doses, which was more effective at controlling blood pressure and saved money for the patient and health care costs, in general.

Spectrum Health Chief Medical Officer Dr. John MacKeigan, who was chairman of MMPC, a large multi-specialty physicians practice that was purchased by Spectrum Health in July, said the service is helpful. The ever-growing number of drugs, both prescription and over-the-counter, the number of doctors a patient has, allergies, side effects, interactions between drugs and patient education combine to make medications a challenge for doctors, he said.

“There needs to be a pharmacist to be part and parcel of that process,” MacKeigan said.

Karin Proos, director of pharmacy for MMPC, said that the patient-centered medical home approach being instituted in primary care is ideal for incorporating medication therapy management.

“With that concept and that team approach, medication is a huge piece,” Proos said.

MacKeigan said pharmacists rarely are employed at doctors’ offices. “They know the medications, the side effects far better than anybody else in the health care team — better than physicians,” he said. “But logically and economically, it’s not feasible to pay a PharmD (someone who holds a doctorate in pharmacy) to be in the office all the time. The dollars are not there.”

The pilot program, which is funded by the Michigan Pharmacists Foundation, asks, “Could it be self-sustaining on a cost basis if we were reimbursed by insurance companies at a rate that would support a PharmD?” MacKeigan asked.

Chase said the federal law that created Medicare Part D for prescription coverage establishes a coding mechanism for billing payers, such as government programs and commercial insurers, for pharmacy services including medication therapy management.

“How can we increase the number of pharmacists able to bill and get paid for their services?” Chase asked. “We know these codes are out there. How can someone like me who wants to go into individual practice bring value at MMPC? If we can bill for our services, we can bring money into the office.”

The pilot program is being run in conjunction with Priority Health, which has agreed to pay MMPC for medication therapy management for non-Medicare members, said Erica Clark, senior clinical pharmacy manager at the health insurer owned by Spectrum Health.

“It is a unique opportunity,” Clark said. “Currently, even nationwide — let alone in the state of Michigan — there’s not a lot of health plans that reimburse for the MTM CPT code for a non-Medicare population.”

Clark said Priority Health is involved in a similar pilot program with another physician practice, as well. She said no data has been reviewed yet, but she is hopeful the program can save health care dollars, not only by streamlining prescriptions, but also by preventing other drug-related costs such as non-adherence and adverse drug reactions that lead to hospitalization and poor health outcomes.

About 450 non-Medicare members of Priority Health are eligible to participate in the pilot program, and Chase said she has counseled about 100 so far.

“Some practices that have really come on board with the patient-centered medical home philosophy are looking at, ‘Do we put a pharmacist on our team as part of a comprehensive team for patients?’” Clark said. “I think it’s an exciting thing. If it’s successful, it will open a lot of opportunities that have not been readily available for pharmacists in the past.”

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