Mtm Presentation

MTM: Physician and Pharmacist Collaboration Laura M. Traynor, Pharm.D., BCPS Glenn H. Nordehn, D.O. Collaborators at: Gateway Family Health Clinic, Moose Lake & UMD Pharmacy & Med schools.

Collaborators We share an office at Gateway Family Health Clinic in Moose Lake. We share patient management. We share information & ideas.

Today’s presentation: Physician and Pharmacist Communication in Medication Therapy Management We address: The communication’s past … The communication’s present … The communication’s possible future: Medication Therapy Management.

The communication’s past … Physicians phoned the pharmacist for prescribing advice. Physicians visited the pharmacy - a social get away from the grind. Pharmacists and physicians had coffee breaks together. Physicians were welcome behind the pharmacy counter. Pharmacists and physicians exchanged “professional courtesy”; they did not charge each other. The number of prescriptions filled in a day at a pharmacy was manageable.

The communication’s present … Physicians stopped calling the pharmacists. (We don’t know each other.) The pharmacy is no longer a social place for the physician. (Practices are larger - there is the social aspect in the clinic.) Coffee break ? Professional courtesy is gone. (Most physicians and pharmacists have health insurance with presciption coverage.) The number of prescriptions filled at a pharmacy has soared.

The communication’s present … J.K. Kallail studied the communication’s present. –

Kallail, J.K.et. al., in “Pharmacy-Physician Communications.” Journal of the American Pharmacists Association, Sept/Oct 2006, Vol. 46, No. 5, pp 618-20.

Pharmacist - physician communications breakdown: 95%: for a refill (fax or electronic). 1.3%: omitted information on a prescription. (quantity; directions; etc.) 1.7%: Need information (a license number - etc. - of the physician. 1.7%: Pharmacy recommends a non clinically relevant change in the prescription. 0.16%: Pharmacy recommends clinically relevant prescription change.

The communication’s present … Possible reasons 0.16% of communications have clinical relevance: Number of prescription numbers filled has soared. Pharmacist numbers have not proportionally soared. Costs have soared. Prescription advice is given at the pharmacy but it is not well coordinated with the physician.

The communication’s possible future: MTM. MTM: Optimizing therapeutic outcomes for individual patients. Ashville: includes an MTM model that fosters communication between physician and pharmacist. Overall better health of patients. Overall increased prescription use. Reduced non-prescription health costs. Overall reduced costs. Non-prescription health costs over-ride increased prescription costs.

Overall increased prescription use. Decreased cost with increased prescription use? Patients were taking the medications they needed. They became healthier. They stayed out of the hospital. Costs went down. The cost reduction from non-medication costs outweighed the cost increase of increase prescription use.

An Animation (based upon trends to give a visual.) Time period before 2008: the soaring costs. Time period after 2008: what could happen by applying an MTM model. First, watch each of the five variables move over time. Then, we’ll slow down the animation.

Change to video setting …

The message: MTM improves health & reduces costs. The Orange bubble (total costs) and Green bubble (pharmacy input - MTM) like to be together.

And further, the Ashville Project: Decreased total health costs Decreased sick days Improved quality measures

Asheville Total Health Care Costs1 Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173-84.

1

$8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000

Mean Cost / Patient / Year $1,000 $0 Baseline

1

2

3

4

Follow-up Year Medical $

January 2008

Diabetes Rx

Other Rx

5

Average Annual Diabetic Sick-Leave Usage (City of Asheville) 14

12.6

12 10 8

8.46 6

5.68 5.81 5.67 6.01

6 4 2 0 Year Year2 1 YearYear 3 Year 4 Year 5 6 Baseline January 2008

A little closer to home… 6 Fairview Clinics in the Twin Cities BCBS members 18 years and older 1 or more of 12 medical conditions 2 or more historical health claims related to those medical conditions Pharmacists saw 285 patients in 684 encounters J Am Pharm Assoc. 2008;48:203–211

BCBS Minnesota Study Clinical and Quality Outcomes Results 637 drug therapy problems (2.2/patient) – 40% indication, 30% effectiveness, 20% safety concerns, and 10% compliance – More than 1/3 required need for additional therapy

78% resolved with out direct physician involvement – 22% required direct 71% treatment group met HEDIS BP measures vs. 59% controls (p < 0.03) 52% met HEDIS cholesterol goals vs. 30% controls (p = 0.00013) March 2008

BCBS Minnesota Study Economic Outcomes Results Intervention group prior year expenditures averaged $11,965 and decreased 31.5% to $8,197 post-intervention – – –

57.9%  facilities 11.1%  professional 19.7%  Rx expenditures

Total health care $  31.5% from $2,225,540 to $1,524,703 a difference of $700,837 Cost MTM = $44,528 Cost of co-payments, co-insurance and deductibles and 3rd party payer cost = $104,028 Benefit attributable to MTM = $552,281 ROI = $12.40 for every $1 invested March 2008

Conclusions Pharmacists and physicians can work together to improve health and decrease costs for patients with chronic conditions