Cardinal Health’s Brad Tice said a closer look — actually, a broader look — needs to be taken at the full benefits resulting from medication therapy management (MTM).

Brad Tice

In a point-of-view article on Cardinal’s Essential Insights blog page, Tice — director of marketing and product management for performance and clinical outcomes at Cardinal — noted that utilization of MTM services isn’t where it should be because much of the savings they yield comes well after their cost is accounted for.

“Medication therapy management has established itself as mutually beneficial for payers, patients and pharmacists, yet its adoption has been slower than expected. Why? I believe the reason is because the impressive return on investment MTM can have for payers is not easily measured or fully understood,” Tice wrote in the article, titled “How to Maximize Total Return for Medication Therapy Management.”

“As I stated in a previous article on this topic, a pharmacist delivering a 30-minute MTM consultation can be an extremely cost-effective way to reduce medical costs, both today and in the future. It’s a bit of a puzzle why MTM isn’t already a routine part of all health plan offerings aimed at this important patient group.”

One explanation for slow MTM adoption, he said, is that the complexity of the health care system can cloak MTM’s proven value. He said three key obstacles include the following: timing, in terms of when the savings and health benefits are realized; cost allocation, since MTM is often considered a pharmacy program but drives tremendous benefits with medical claims; and financial incentives surrounding MTM programs.

“Health plans that focus on MTM’s total return on investment — the big picture — will gain an essential competitive advantage in the marketplace,” Tice said.

The potential savings is certainly attractive for providers of health benefits, he pointed out, with the cost of nonadherence to medications estimated at $290 billion annually by the Network for Excellence in Health Innovation (NEHI).

“While some MTM ROI can be immediate, it can take a while to accurately measure MTM’s total return. A prevented hospital readmission stay may show up immediately, but longer-term savings, like avoided chronic disease progression, may show up down the road, even though the initial MTM expense shows up today,” Tice observed. “There can be a timing gap. Health plans that understand the gap and value it properly will maximize their ROI.”