The Impact of MTM Software on Healthcare
MTM software programs are essential to healthcare providers for delivering patient education, medication adherence and adverse drug events. However, the effectiveness of these programs depends on their components and how they are given.
Several factors influence the success of a program, including its cost, intensity, delivery system and the health plan’s policies on MTM eligibility. Identifying models and components demonstrating demonstrably effective outcomes will help patients, healthcare providers, and the Centers for Medicare & Medicaid Services (CMS) understand what works well in which settings and with which patients.
Medication Adherence
Medication adherence is a critical part of a successful medication therapy management program. It can help lower costs and improve outcomes for beneficiaries with chronic diseases.
However, adherence is often difficult for patients suffering from complex conditions. They may misunderstand their diagnosis, struggle with social determinants of health, or have trouble accessing pharmacies.
As a result, nonadherence to medications can lead to increased medical costs and preventable hospitalizations. It can also create anxiety and worry among family members.
For this reason, a successful medication adherence program should be patient-centric and include all the tools patients need to manage their adherence successfully. This includes a patient education program, medication safety measures, and support to help them achieve their adherence goals.
Medication adherence is one of the most significant factors in achieving health outcomes and reducing healthcare costs. It is estimated that if nonadherent patients adhere to their medications, $500 billion in annual medical costs could be avoided. In addition, it can reduce the risk of hospitalizations and other healthcare events and improve the quality of life for individuals with chronic illnesses.
Medication Safety
Medication Safety is an essential factor in the success of any medication therapy management (MTM) program. MTM aims to identify and resolve drug-related problems, such as adverse reactions, overdoses, or other medication side effects.
One of the most common challenges in implementing an MTM program is collecting patient-specific information to facilitate the review process and to track results. To help meet this challenge, pharmacists and a programming company collaborated on creating an automated MTM software for its Part D members.
The new system increased pharmacy efficiency significantly, identifying and verifying drug regimen reviews and resolving a 300% increase in identified DRPs. This resulted in a 95% rate of fulfilled MTM visits.
Pharmacists also implemented custom assessments about a member’s overall health, medications, and access to healthcare. Nurses use these data to triage patients into appropriate disease management, assistance programs, or behavioral healthcare services.
MTM providers also incorporated patient education as a critical component of their program. Patient education involved active listening, goal setting, and other interactive forms of communication to improve patient acceptance and activation. It was documented in the member’s record and included patient-centered adherence plans, goal-setting sheets, and other materials for self-management of medication regimens.
Patient Education
Medication therapy management (MTM) programs are designed to optimize medication usage and adherence for Medicare Part D enrollees. They are intended to reduce adverse drug events, medication misuse, and other drug-related problems.
In addition, MTM software provide education and counseling to patients to reduce their risk of healthcare-related complications and improve their overall well-being. They also improve medication adherence, which reduces hospitalization and medication costs.
Despite the importance of MTM to healthcare, payers often need to reimburse MTM services universally. This may be due to various factors, including differences in eligibility criteria, enrollment methods, and intervention types.
Some health plans, such as Tufts Health Plan, have MTM programs available to all Medicare Part D beneficiaries with multiple chronic conditions. They target these members, who are likely to incur annual costs for covered Part D drugs that exceed a predetermined level (“annual cost threshold”).
At Health Net, pharmacists used a new software program to automate their MTM and drug regimen reviews (DRPs). This workflow queue allows members to load their medication claims into the system based on their eligibility requirements and automatically runs through a series of algorithms to identify specific DRPs. In addition, the program allows pharmacists to capture and update DRPs each month as members are added or removed from the system.
Patient Engagement
Patient engagement is an important part of healthcare because patients are the ultimate gatekeepers regarding their choices and behavior. Whether they forget to take their medications, do not understand what is expected of them or do not know how to get to their care providers, patients often need help understanding and acting on their medication regimens.
Many health plans use MTM programs to improve patient medication adherence, particularly for individuals with chronic conditions. Payers have multiple options for engaging patients in MTM efforts, including risk stratification to identify high-risk patients and to develop targeted campaigns based on those risks.
In addition, payers can change payment structures to reduce financial barriers to adherence and tailor cost sharing based on a patient’s most critical medical needs. They can also conduct targeted medication education campaigns to help patients and their families better understand their treatment and care plans.
MTM is a complex process that requires knowledge and skills to be successfully implemented by pharmacists. Therefore, pharmacists need specialized training to overcome suboptimal MTM implementation rates. This training should focus on integrating the core elements of MTM into the provider’s workflow and improving their ability to adapt to the nuances of the setting. It should also foster self-belief, including providing support and information about antecedents.
