Health Care and Human Resources

Insurer invests $3M in medication therapy management

Priority Health will add pharmacist to patient care teams.

April 22, 2016
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An insurer is investing $3 million this year in medication therapy management following a successful pilot program with its Medicare members.

Priority Health announced earlier this month the success of its Medication Therapy Management program, or MTM, which saw a cost savings of $60 per member/per month over a 12-month period and $66 per member/per month over 24 months, has led the organization to expand the program for 2016.

Erica Clark, clinical pharmacy director for Priority Health, said approximately $2 million will go toward continuing to support Priority Health’s community pharmacy outreach in the Medicare and commercial space, and the other $1 million would be used to support the organization’s advanced medical home model, which embeds a pharmacist within the care team.

Clark said Priority Health began to “robustly focus” on Medication Therapy Management in 2011 by partnering with Des Moines-based health consultant Outcomes MTM.

“They are a leader in the MTM space,” she said. “They bring to the table a network of pharmacists from across the nation who can complete MTM interventions on behalf of our members and document them on their platform, and then provide robust reporting back to us on the types of interventions that are made.”

Several major retail pharmacies across the country are included in the network.

“In Michigan, its Meijer, Walgreens, Rite Aid, SpartanNash,” Clark said.

“Nationally, we have a presence, too. So for our snowbirds who travel out of the state or for members who live out of state but have coverage through Priority Health, they can access the service wherever they go.”

Clark said based on the savings being realized through the program with the Medicare population during the first four years, Priority Health decided last June to expand the program to its commercial members, which includes employer-based members and individual members.

This year, the program will go a step further by focusing on the advanced medical home model.

“That is the model where you have the primary care physician quarterbacking the care of the member along with a care team,” she said. “For the first time, we are able to place a pharmacist on the care team.”

The pharmacist works side-by-side with the care team under a collaborative practice agreement, performing a handful of duties that include comprehensive medication reviews for members with significant medication use.

“The pharmacists, in many ways, are taking over medication management from the physicians,” Clark said.

The goal is to improve patient care and reduce costs for the member and payer. As the program continues, Clark said she expects to see more opportunities for savings to arise.

“I think where we will see additional savings in the future will be by fine-tuning our targeting to identify the patients in most need and get them the services that help them the most, and by making the program more available.

“As we grow our network of pharmacists and grow this model of pharmacists who are embedded in this advanced medical home, the impact of the program grows.”

Clark said she believes employers have a lot to gain from the MTM program.

“The cost savings the program can offer — that $60 per member/per month that we found in the Medicare population — we expect similar results in the commercial employer group,” she said.

Clark said there is evolving data that suggests the MTM program improves patient health, which in turn decreases their chance for admittance or re-admittance to the hospital.

“I think that resonates with employers. It keeps their employees more productive and keeps them at work,” she said.

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