Donald Morisky, ScD, MSPH, ScM Steve Trubow, Olympic Labs

Transcription

1 The MHIS Morisky Medication Adherence Protocol, the Computerized Adaptive Tests for Mental Health & the 2016 CMS Enhanced Medication Therapy Management Model Donald Morisky, ScD, MSPH, ScM Steve Trubow, Olympic Labs

2 Why is medication non-adherence for diabetes important to patient safety? According to the 2016 CMS 5 Star Patient Safety Ratings below, Out of 20 PDPs, 15 or 75% received failing or poor patient safety ratings, five or 25% received average ratings, while no Prescription Drug Plans (PDPs) received above average or excellent ratings for medication adherence for diabetes.

3 Why is completing medication therapy management programs important to patient safety? Out of 20 PDP s below, twelve or 60% received failing or poor ratings, five received average ratings, and only one received above average and one received excellent ratings for the completion of MTM.

4 In Congressional Testimony 10/21/2016, Tim Gronniger, Director of Delivery System Reform at CMS testified that only 11% of eligible targeted beneficiaries. complete MTM programs with high levels of adherence. This leaves as many as 89% of beneficiaries, most chronic disease patients who discontinued MTM at elevated risk levels for treatment nonadherence, medical complications and premature death. While MTM is supposed to be patient centric and actively engage the non-adherent patient in high touch interventions, Gronniger testified to the opposite, Performance data suggests that PDPs focus on meeting minimal technical requirements for MTM rather than trying to identify opportunities to improve the health of Medicare beneficiaries. CMS Announces Part D Enhanced Medication Therapy Management (MTM) Model To Improve Medication Adherence 09/25/2015 Current MTM, one-size-fits-all, approaches to targeted beneficiary outreach will not be considered sufficient to significantly increase engagement in effective MTM medication adherence interventions. The Enhanced MTM Model must Optimize medication adherence for high-risk patients with high-value chronic medication regimens Provide metrics for identifying the risk levels for medication non-adherence and the barriers that prevent optimized medication use.

5 The MPR & the PDC are based on an assumption that prescription filing & refilling patterns correspond to the patient s medicationtaking behaviors and that the medication is taken exactly as prescribed. There is no clinical evidence to support using the MPR or the PDC as the threshold for measuring or monitoring medication adherence or the barriers to optimizing adherence. Although simple to measure, MPR and PDC pill counts do not accurately capture the exact timing of medication taking. Using pharmacy data to measure adherence can inform us that a prescription was filled but cannot confirm that patients take medications as directed. The most significant limitation of the MPR and the PDC is the lack of ability to assess the clinical meaning of an observed improvement or failure of the patient take their medication. The Morisky Medication Adherence Scale (MMAS-8) actively engages the patient to quantify the level of risk for non-adherence and the precisely measure the clinical impact on patient health outcomes In 2015 the American Medical Association Continuing Education program certified the MMAS-8 to measure and monitor medication non-adherence. The AMA reported the Protocol has the only validated and standardized adherence measure that can differentiate and quantify intentional and nonintentional medication nonadherence. The Mental Health Informatics System (MHIS) uses validated dimensional assessment measures for barriers that modify adherence, depression, anxiety, mania, and substance use with the most recent clinical outcomes, all correlated for the single individual patient to accurately predict the risk levels of non-adherence and the changing severity of the barriers that make it difficult to optimize non-adherence.

6 MHIS: Morisky Medication Adherence Screening and Assessments The Protocol identifies the risk levels for medication non-adherence & precisely measures the severity of depression, anxiety, mania, substance use and the risk of suicidal behaviors.

7 The MHIS Protocols identify and continuously monitor the real time clinical results of mental health, substance use, suicide and medication adherence assessments for chronic disease, psychiatric, and chemical dependency patients and correlate them with physical measures with a clear link to the risks of suicide, overdose, uncontrolled blood pressure, uncontrolled blood sugar, uncontrolled cholesterol and worsening kidney function.