Introduction to Medication Management Systems, Inc. Comprehensive Medication Therapy Management Solutions

Transcription

1 Introduction to Medication Management Systems, Inc. Comprehensive Medication Therapy Management Solutions

2 Vision Medication Management Systems, Inc. (MMS) envisions a health care system in which all patients realize the benefits of medication management services which result in appropriate, effective, safe and adherent medication use. Mission MMS s mission is to improve the efficiency and effectiveness of medications for the benefit of patients and payers in the U.S. and around the world. We accomplish this through the delivery and support of comprehensive, patient centered medication management services and technologies which help to identify and resolve patient drug therapy problems and generate value for health care payers. Background MMS is a Minnesota based company dedicated to advancing healthcare by facilitating the appropriate use of medications and ensuring drug therapy appropriateness, effectiveness, safety and adherence. The company s medication therapy management (MTM) services are founded upon the practice of patient-centered pharmaceutical care, supported by a robust clinical decision support system and electronic therapeutic record - the Assurance System - developed, researched and validated by MMS s founders. MMS s leadership team has experience in developing and implementing successful MTM services in a wide variety of healthcare settings. MMS s proprietary clinical decision support system and electronic therapeutic record, the Assurance System, has been used to document the care of face-to-face and telephonic patient encounters for over 350,000 patient encounters. Pharmaceutical care practitioners have evaluated more than 500,000 medical conditions and identified and resolved more than 700,000 drug therapy problems - all documented in MMS Assurance System. MMS has worked with pharmacists across all pharmacy settings throughout the United States, Puerto Rico and in 16 different countries. Our staff has established comprehensive MTM services in clinics, health systems, community pharmacies, and call center environments. We have supported and delivered comprehensive MTM services to Native American populations, underserved populations, practices with collaborative agreements with physicians, and practices which support students and faculty from colleges of pharmacy Medication Management Systems, Inc. 2

3 Services and Technologies For Payers and Health Plans MyMedsManagement is a comprehensive, patient centered medication management service administered and delivered by MMS. Participants interact one on one with a specially trained pharmacist to ensure that all medication therapies are appropriate and effective for the intended use, are safe for the patient to take and are able to be taken as intended. Published data demonstrates that this service reduces total healthcare costs by almost 1/3 and improves patient healthcare quality. Assurance System is a comprehensive technology platform for MTM program administrators, supporting delivery of MTM services provided by internal health plan pharmacists and staff, networks of external contracted pharmacists and/or call center-based practitioners. The Assurance System includes a longitudinal electronic therapeutic record chronicling patient usage of medications. The system provides for the creation of evidence-based patient care plans as well as the documentation and reporting of pharmacist interventions and the status of therapeutic goals over time. The system helps practitioners identify and resolve the drug therapy problems which prevent patients from achieving desired therapeutic goals. The system can interface with client eligibility data and pharmacy and medical claims data against which clinical rules can be applied as triggers to generate clinical alerts and action items for system users or to cull from population data those health plan members who qualify as candidates for MTM services. The system also contains robust analysis and reporting capabilities for the management and delivery of MTM services which exceed Federal government program requirements Medication Management Systems, Inc. 3

4 For Practitioners Assurance Pharmaceutical Care System Training Program equips pharmacists and other healthcare practitioners with the skills required to deliver pharmaceutical care to patients as part of a comprehensive, patient centered medication management service. Assurance System is a clinical decision support system, electronic therapeutic record and practice management system which supports the delivery and documentation of pharmaceutical care to patients. Assurance System functionality includes: a) comprehensive electronic therapeutic record (linking prescription and over the counter drugs, vitamins and dietary supplements to medical conditions); b) tools which help practitioners to identify, track, and resolve a patient s drug therapy problems; c) custom patient care plans; d) documentation and reporting of patient therapeutic goals across time; and e) claims and billing functions. With the Assurance System, practitioners can demonstrate both the clinical outcomes and economic benefits of comprehensive, patient centered medication management services Medication Management Systems, Inc. 4

5 Medication Therapy Management Solutions MMS provides robust end-to-end comprehensive MTM solutions which include; determining eligibility criteria, processes to facilitate beneficiary recruitment and enrollment, scheduling of MTM services delivery by pharmacists, network administration, call center service, data analytics, outcomes reporting and CMScompliant program reporting. These solutions are available on an a la carte basis as well. MMS delivers MTM solutions to Medicare Advantage Part D Plans, Medicare Prescription Drug Plans, PBMs, health plans, and employers. MMS s comprehensive MTM solutions meet or exceed the Medicare Part D MTM program requirements set forth by CMS. MMS MTM solutions have been shown to deliver a return on investment of as high as twelve to one 1. No other company has more experience and expertise with MTM anywhere in the world. MMS MTM solutions help customers to: Improve patient care with measurable endpoints Increase administrative efficiency by 50% Reduce CMS reporting time and IT system resources by 70% Meet all CMS MTM program requirements CONTACT: Tom Albers, R.Ph. Vice President, Sales and Marketing Two Carlson Parkway, Suite 402 Plymouth, MN talbers1@medsmanagement.com Isetts, et al. J Am Pharm Assoc. 2008;48(2): Clinical and economic outcomes of medication therapy management services: The Minnesota experience Medication Management Systems, Inc. 5

6 Eligibility Criteria MTM program administrators employ MMS s MTM solutions to help determine and optimize the eligibility criteria selection for their plan. MMS works with MTM program sponsors to determine how best to structure their plan s eligibility criteria to align with their program objectives. By evaluating the number of chronic conditions and the associated medications and coordinating the frequency of when eligibility criteria are applied, the number of beneficiaries meeting the eligibility criteria can be managed to meet program budget and performance objectives. Knowing what criteria will drive beneficiary eligibility will have a direct impact on the resources that will be required to manage MTM programs. Having this level of information can help with understanding how to prepare for beneficiary outreach recruitment and enrollment campaigns. For example the number of outreach packets or phone calls necessary to facilitate the enrollment process may be able to be reduced. Knowing when to expect beneficiaries to become eligible for MTM services allows for better management of staff time and the IT resources required for managing the MTM program. By evaluating the combination of medications, medical conditions, the frequency of when the eligibility criteria are applied, and our outreach strategy, Medication Management Systems recommended detailed plans to help us better manage our MTM program. We selected MMS based on their understanding of the complexities of Medicare Part D MTM and technology solutions to make our department more efficient. customer quote Prime Therapeutics, Inc Medication Management Systems, Inc. 6

7 Enrollment, Ongoing Recruitment and Follow-Up MTM program sponsors can employ the Assurance System capabilities for managing their MTM program recruitment and enrollment processes: MTM programs can integrate beneficiary demographic and eligibility data with pharmacy claims data into the Assurance System and use the system s trigger functionality to identify MTM eligible beneficiaries meeting the plan s MTM program requirements. MTM programs can automatically merge demographic and other data in the Assurance System into MTM enrollment letters in a file format structure ready for mail fulfillment. These files may be printed in-house or sent to a fulfillment vendor for distribution. MMS has a preferred fulfillment vendor and can offer volume pricing options. MTM programs can document MTM eligible beneficiary participation or opt-out status in the Assurance System to complete required reporting and statistics around program participation. The Assurance System has robust functionality for the MTM programs to schedule a beneficiary s appointments for comprehensive medication review or targeted medication review with MTM pharmacists Medication Management Systems, Inc. 7

8 Annual Comprehensive Medication Review For Medicare Part D MTM services, CMS defines a comprehensive medication review (CMR) as: a review of a beneficiary s medications, including prescription, over-thecounter (OTC) medications, herbal therapies, and dietary supplements, that is intended to aid in assessing medication therapy and optimizing patient outcomes. A CMRs must include: A review of medications to assess medication use and identify medication related problems Offer an interactive, person-to-person consultation Provision of an individual written summary to the beneficiary The annual CMR for each MTM eligible beneficiary can be performed as either a faceto-face interaction with a practitioner or by telephone. MMS s MTM solutions facilitate client compliance to this requirement by Assurance System support of inhouse staff or by provision of fully out sourced CMR services from MMS s Pharmaceutical Care Practice Network that can provide services face-to-face or via telephone. CMR by MMS INTERACTIVE, INFORMATIVE, AND PATIENT CENTERED Identify any of the beneficiary s medication goals or concerns Build a comprehensive medication list and how the patient is taking each medication. Link all medications with the reason why the patient is taking them. Review every medication to assess the appropriateness of the indication, effectiveness, safety and compliance. Identify and design a plan to resolve any drug therapy problems. Provide and additional education on the patient s medications or conditions. MMS pharmaceutical care process includes review of prescription, over-the-counter medications, herbal therapies, and dietary supplements. The review will include an understanding of the patient s medication experience, a review of systems, a medication history, a current medication profile, a review of allergies and adverse drug reactions. This review will result in the identification of drug therapy problems preventing the beneficiary from achieving desired goals of therapy. This assessment will result in a personal care plan developed for each participant. The care plan will involve patient specific goals of therapy and interventions necessary to optimize the patient s medication experience. All MMS CMRs are documented in the Assurance System and result in the creation of medication action plan and MTM visit summary documents for use with the beneficiary and primary physician Medication Management Systems, Inc. 8

9 Targeted Medication Review For Medicare Part D MTM services, CMS defines a targeted medication review (TMR) as: ongoing monitoring to assess medication use since the CMR, monitor whether any unresolved issues need attention, new drug therapy problems have arisen, or if the beneficiary has experiences a transition in care. MTM program sponsors must assess the findings of TMRs to determine if a follow-up intervention is necessary and if the intervention is warranted for the beneficiary and or prescriber. These assessments can be person-to-person and/or system generated. TMRs by MMS AUTOMATED, DESCRIPTIVE AND DATA DRIVEN Interactive TMR: For each beneficiary who has received a CMR, on a quarterly basis a MMS pharmacist will evaluate updated pharmacy claims records in the Assurance System in order to determine if recommendations communicated in the CMR have resulted in desired outcomes. Review and updating the medication list Identify and review changes in medication claims history Assess the resolution of the previously identified drug therapy problems Assess for the presence of new problems Document acceptance of medication change recommendations Automated TMR: Integration of data driven TMRs Particular clinical triggers (data point combinations) are used to query the claims history and data housed in the Assurance System and generate a Triggered Patient List. From the Triggered Patient List, a MMS pharmacist reviews each beneficiary s Assurance System record for the clinical appropriateness of the trigger. If identified as appropriate, a standardized communication report or letter is generated for the beneficiary and/or the beneficiary s prescriber. A standardized communication letter or report is sent to the designated audience requesting specific action or providing education based on the clinical trigger Medication Management Systems, Inc. 9

10 Reporting and Outcomes Measurement The Assurance System provides MTM program administrators with all of the information necessary to meet regulatory eporting requirements, including: The number of annual CMRs, offered and provided. The number of targeted medication reviews. The number of provider interventions. The changes in therapy directly resulting from the MTM interventions All MTM reporting can be managed with the Assurance System. The report function includes claims integration processes which allow MMS clients to report both program process elements and financial required elements. Presently, MMS clients use a combination of their pharmacy claims system and the Assurance System to complete the processing of CMS reports. This function has allowed clients to add efficiency to their program and reduce the IT resources needed to complete CMS MTM required reports by as much as 70%. MMS s Assurance System already contains demonstrable functionality and data to report outcomes that may be required in the future. These parameters include: The number and type of drug therapy problems (this includes unnecessary drug therapy, inappropriate doses, drug interactions, adverse drug reactions and compliance levels) Clinical outcome parameters for the targeted diseases (HEDIS criteria met, etc.) Customer satisfaction surveys Medication Management Systems, Inc. 10