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.