Today, during the COVID-19 pandemic, telemedicine is evolving, and providers are regularly using telehealth to visit with patients. We are seeing many private insurers adopting rules to provide guidelines around how services are distributed and paid for. Most health insurance companies, including Medicare, will now pay for a remote telemedicine healthcare visit like a visit to the clinic.
Pharmacists are in a highly visible and patient-accessible role and are being integrated into telehealth solutions. Telepharmacy solutions are state-specific often determined via legislative rules. Much of the backlog in pharmacists covering these roles surrounds the legal and payment issues of gaining provider status.
One way a pharmacist can expand their role in telepharmacy, a branch of telemedicine conducted by a pharmacist, is through Medication Therapy Management Programs (or MTM). MTM services may be covered under Medicare, Medicaid, or private insurance.
Medication Therapy Management (MTM)
It is well known that medication adherence can result in better clinical outcomes and lower health care costs. Medication therapy management (MTM) is not only an effective tactic to improve adherence, but it is also effective at helping independent pharmacies to grow their business.
For example, a patient might conference with a pharmacist to have a full overview of their medications two weeks after being discharged from the hospital. Side effects, dosing, cost, and other issues that lead to side effects or non-adherence can be reviewed. Medication therapy management (MTM) can prevent hospital readmission, dangerous side effects, and drug interactions.
There are three types of MTM:
- Targeted interventions consist of a brief in-person or phone consultations between pharmacists and patients, average approximately 15 minutes in length, usually focus on a single prescription, address proper usage, side effects, and challenges to staying adherent.
- Targeted Medication Reviews (TMRs) consist of a brief (15 minutes or less) follow-up consultations, done over the phone or in-person, every quarter. These follow up reviews are performed following yearly comprehensive medication reviews (CMRs).
- Comprehensive medication reviews (CMRs) are in-person consultations between pharmacists and patients, average approximately 1 hour in length, collect patient clinical info such as medication history, over-the-counter medications being used, and medication-related side effects, create plans to address any medication-related issues with patients, their caregivers, or providers. This MTM is also one of the Star Rating measures that pharmacies are evaluated on.
Understanding the Challenge
The challenge independent pharmacies face with MTMs is how to add them in an efficient enough manner where they produce the best possible clinical results for their customers, and business results for the pharmacy. Several strategies that can be employed to help drive MTM efficiency:
- Set hard stop limits on CMR consultations at 45 to 60 minutes
- Review the patient’s medication history before the scheduled consultation
- Schedule specific days/times when CMRs can be the focus
- Have an agenda mapped out for CMRs including time to conduct:
- Patient interview
- Drug review
- Drug therapy problems (DTPs)
- Develop a plan for DTPs
- Document CMR session
If your pharmacy has not branched into offering Medication Therapy Management services, then this is the time to expand. Not only will your pharmacy benefit from the extra revenue but offering MTM services will help increase the pharmacists’ role as a health care provider.
Through our partnerships, PPSC has the tools you need to implement MTM services in your pharmacy. From the building blocks of an MTM business model to details of service implementation, we have the solutions you need to implement MTM in your pharmacy.
To learn more, please connect with us today.