FEATURED: Point of View
Brad Tice R.Ph., PharmD, MBA, FAPhA
Medication Therapy Management
When a new solution benefits everyone in the healthcare system, yet still isn't being adopted, it's time to ask: What's holding the parties back?
Medication Management Therapy (MTM) has established itself as mutually beneficial for payers, patients and pharmacists, yet its adoption has been slower than expected. Why? I believe the reason is because the impressive return on investment MTM can have for payers is not easily measured or fully understood. This article seeks to remedy that. I will explain what's needed for a full accounting of the financial value and benefits of MTM.
As I stated in a previous article on this topic, a pharmacist delivering a 30-minute MTM consultation can be an extremely cost effective way to reduce medical costs, both today and in the future. It's a bit of a puzzle why MTM isn't already a routine part of all health plan offerings aimed at this important patient group.
I believe that one explanation for slow MTM adoption is that the complexity of the healthcare system can obscure MTM's proven value. The three main obstacles to measuring the full impact of MTM programs are:
- Timing issues related to when savings and health benefits are realized
- Cost allocation, as the MTM program is often viewed as a pharmacy program, yet drives tremendous benefits with medical claims
- Financial incentives surrounding MTM programs
Failing to measure the full impact of MTM programs is difficult to do, yet not doing so is a fatal analytical error.
It's About Time
Health plans that focus on MTM's total return on investment — the big picture — will gain an essential competitive advantage in the marketplace. Today, the cost of MTM is quantified immediately even though the some of the savings it delivers are not.
Generally, a key chunk of savings generated from MTM services tend to be realized in outer years — as patients remain healthy, over time — while the program costs are incurred immediately. The MTM consultations immediately help improve medication adherence and can reduce preventable hospital readmissions. However, as the patient continues to stay healthier over time, the benefits of the MTM consultation accumulate and grow substantially. As such, it is easy to overlook the benefits from long-term health improvement when considering the value of the MTM consultation. Another timing issue — the delay in medical claims adjudication — also impacts the ability to measure the immediate value of MTM services.