Among and between health care providers, including pharmacists, there have been MTM pilot projects and some test collaborations. But none has proven to merit a ramp-up to anything representing a meaningful scale.
There is solid rationale for the practice of MTM to exist and to become an integral part of high-cost patient management. Generally accepted is the point that some 3% of health care patients cause approximately 50% of all health care expense. That is just a statement of expense. Optimizing patient outcomes takes this point to a higher level. At any chain pharmacy these patients have patient medication profiles detailing multiple medications from multiple physicians. The potential for misadventure is as large as it is real.
Health conditions for these patients have been well documented as having the potential for medication misadventures. But thus far, except for medication interactions that are episodically caught and corrected, there is no care plan organization among providers to optimize multiple medication therapy for a high-risk, high-cost patient with multiple medical conditions.
Neither has a payment mechanism been crafted to compensate pharmacists as part of a care team, which makes it abundantly obvious why senior chain pharmacy management has little or no incentive to develop the service as part of a business plan that must produce an acceptable return on investment.
Dissecting and reconnecting these parts in an effort to build a patient care-oriented pharmacy reimbursement business model requires some fundamental changes.
First among them is recognizing pharmacists certified in MTM care as medical providers. Without this becoming reality, all else is nearly meaningless. As medical providers, pharmacists and/or the business entity employing them could bill for medical services provided. Time and space does not allow in this writing to detail all that is involved in bringing this about.
In brief, expect it to be a state by state effort, as there is little trust that it could become a federal issue. There is an active effort for this to come about soon in Washington state.
With pharmacists recognized as medical providers, they must be a functioning part of a patient care team. Interestingly, the move to develop accountable care organizations, of which there are now 400 to 500 in the country, presents an encouraging care model in which pharmacists could productively function.
Again, time and space does not provide for considering the details for this to happen. But for it to happen, one item is again fundamental. It is shared data. With shared medical data for a patient in a care management scheme, pharmacists could — under protocol and guidelines — modify or even initiate therapy.
Pharmacists having medical provider status, being a recognized member of a patient care management team and sharing data, provides the foundation for optimizing patient care while significantly reducing care costs. For that, billing and compensation is justified.
But it’s a very tall order.
Robert Coopman is president of Robert Coopman Consultants, based on San Antonio. He can be contacted at [email protected].