Medication Therapy Management in action: Real cases, real results

CONTRIBUTOR

Brad Tice, RPh, PharmD, MBA, FAPhA

Product Leader
Medication Therapy Management
Cardinal Health

Numbers speak louder than words.

Watching Medication Therapy Management (MTM) in action makes it easier to understand why it can produce an impressive return on investment.

In my last article on this topic, I explained how measuring MTM's ROI requires following costs and savings throughout the healthcare system, from pharmacy to emergency room to doctor's office to the patient's home. This measurement can seem tricky because our industry traditionally treats each point of care as a distinct cost center, even though we know healthcare is interconnected. MTM's value is derived from its ability to optimize and coordinate patient care at an underused and affordable location: the pharmacy.

Let me show you how this works in three real-world cases. Each case involves patients with multiple medications and chronic conditions, the population that should be most immediately targeted for MTM services. These cases demonstrate how paying for 30 minutes of a pharmacist's expertise is money well invested.

For privacy reasons, I've changed patient names. Dollar amounts represent national averages. Precise savings for a payer obviously will vary depending on the region and situation. What won't change is the evidence of these true stories: MTM saves money and improves patient care.


Clara, uncontrolled asthma

MTM's savings potential: $21,419

Clara, 37, suffers from uncontrolled asthma, unresponsive depression, pain and nausea. She sees multiple specialists, takes many medications (19) and is an expensive patient in her demographic group.

Before MTM. Clara spent about $2,900 a year on her 19 medications. Due to her asthma, she is the type of patient who frequently landed in the hospital.

MTM review.  Clara’s pharmacists identified five clear problems. Clara overused her short-acting inhaler and lacked a prescription for a long-acting controller inhaler. In addition, one of her 19 medications was a duplicate therapy. In addition, Clara wasn’t taking any medication for depression.

After MTM.  Clara dropped the duplicate therapy and was referred to a physician to restart depression treatment. She stopped using a rescue inhaler as maintenance medicine and got a long-term controller.

Savings. MTM repositioned Clara to avoid emergency rooms and hospital admissions, events that would have cost an estimated $24,500. Clara’s two new medications – for depression and long-term asthma control – added just $188 a year to her total medication bill. Total net savings: $21,419.

MTM Economics 101. Asthma patients who use MTM are six times less likely to have an ER/hospital event, according The Asheville Project’s research. (The peer reviewed article is here.)


Harold, congestive heart failure

MTM’s savings potential: $9,567

Harold, 54, is a smoker who suffers from many chronic health problems: angina, decompensated congestive heart failure (CHF), high blood pressure, diabetes, dyslipidemia and acid reflux.

Before MTM. Harold was taking a dozen medications, sometimes laxly. One obvious therapy was missing. Treatments were not optimized to modern standards. And Harold still smoked.

MTM review. Harold’s pharmacist found four serious problems. Harold wasn’t on an ACE inhibitor, an obvious therapy that had fallen through the cracks. Harold’s CHF treatment was sub-optimal. Harold had poor adherence for two medications and his smoking couldn’t be ignored.

After MTM. Two medications were added, including starting an ACE-I. The pharmacist optimized Harold’s CHF therapy and improved adherence where needed. Harold started a smoking cessation program, too.

Savings. By helping Harold use medicine correctly, MTM put the middle-aged patient on a trajectory to avoid hospitalization for his congestive heart failure, avoiding a $10,900 hospital bill. The medication adjustments added $261 to his annual pharmacy bill, bringing that total cost to $1,333. Total net savings: $9,567.

MTM Economics 101.  Congestive heart failure patients who receive MTM services are 50% less likely to be hospitalized, according to a study done for the Centers for Medicare & Medicaid Services[1].


Kimberly, ulcers, diabetes

MTM’s savings potential: $34,728

Kimberly, 47, has a life deeply entwined with the healthcare system. She struggles with more than a dozen chronic conditions that frequently lead to hospitalization: asthma, diabetes, high blood pressure, overactive bladder, COPD, dyslipidemia, hypothyroidism, anxiety, bipolar disorder, chronic pain, depression, osteoporosis and ulcers.

Before MTM. Kimberly took 25 drugs but did not fully understand the complexity and interactions of her many conditions and medications.

MTM review. Kimberly’s pharmacist zeroed in on four problems. Many of Kimberly’s drugs interacted in problematic ways. Two medications duplicated each other. Kimberly wasn’t prescribed a needed antiplatelet. And she hadn’t received two vaccines, crucial for people in fragile health.

After MTM. Kimberly was vaccinated immediately for flu and pneumonia. Her physician added an antiplatelet medication to her regimen and discontinued another drug. Kimberly was educated about not taking duplicate NSAIDs. The pharmacist developed and reviewed with her an “action plan” to help manage her asthma.

Savings. Kimberly’s medication changes improved her health while having little effect on annual prescription costs of $4,100. The MTM consultation made it possible for this chronically ill and costly patient to avoid an estimated $38,860 in hospital costs, for visits related to pneumonia and gastrointestinal bleeding.

MTM Economics 101.   In October 2015, Medicare will reduce reimbursement for hospitals whose COPD patients (such as Kimberly) are readmitted at higher-than-desired rates.  Vaccines have been shown to be effective in helping prevent readmissions. The study for Medicare previously referenced found that MTM saved an average of $1,034 in hospital costs for those who’d recently been admitted for COPD or CHF.

Why wouldn’t we invest in a service that costs a fraction of the savings that it provides -- especially when an MTM consultation can produce average savings of more than $1,000 (and often times, 30 to 40 times that) per patient? That’s the type of return that MTM produces when applied skillfully to clearly defined cohorts – and when results are measured comprehensively.

Clara, Harold, Kimberly and other chronically ill patients are high-risk, high-cost patients that challenge our industry’s ability to control costs. At the snap of a finger, they can become a (preventable) $10,000 hospital stay. Right now, only 1% of eligible patients are getting MTM services – when these very services can help avoid preventable hospital stays. This treatment gap is one of healthcare’s great financial and clinical opportunities.
 


[1] Marrufo G, Dixit A, Perlroth D, Montesinos A, Rusev E, Packard M. Medication therapy management in a chronically ill population: interim report. Accumen, LCC. January 2010; 1-102.