Potential cost savings of medication therapy management in safety-net clinics

Medical cost associated with chronic disease has been on the rise, and becoming an economic burden on the national level. Almost 50% of the $1.13 trillion national medical expenditure is associated with chronic disease treatments each year in the United States. MTM service provided by pharmacist may be a solution to the problem by improving treatment management and health outcomes through the adjusting of medication regimen and counseling of patients.

In order to determine how MTM services can impact potential cost savings, the study focused on the MTM service that is delivered in safety-net clinics from October 2009 to September 2013 in Maryland. The targeted population was mainly low-income, underserved Latino with age ranging from 26 to 83 years. Pharmacist provided face-to-face consolation and interventions and follow-up appointment as needed.

Within the four years, 110 male and 136 female patients received MTM where over 2,000 medications. There was an average of 8.5 medication and 4.8 chronic diseases per patient. Through the MTM service, 814 medication-related problems are identifying, resulting to an average of 3.3 problems per patient. Among the most common medication-related problems include subtherapeutic dose (38%), nonadherence (19%), and untreated indication (16%). The overall medication-related problems corresponds to $115,220-$614,570 which calculates to $141.55 to $755 for every problem identified.

The total cost of MTM service including the pharmacist’s salary, the administrative and operational cost totals to $57,307, showing that a significant amount of medical cost can be avoid with the pharmacist-provided MTM services. This study validated the importance of MTM services on a both the medical and economic level and proved that it is something that should be implemented into more practice settings to serve a larger population in the health care system.

Truong HA, Groves, CC, Heather BD. et al. Potential cost savings of medication therapy management in safety-net clinics. JAPhA. 2015:55(3):269–272.

JAPhA. 2015:55(3):269–272

TransitionRx: Impact of community pharmacy postdischarge medication therapy management on hospital readmission rate

It has been found that nearly 20% of Medicare patients are readmitted to the hospital within 30 days of discharge. This high incidence of readmission can lead to increased costs for Medicare and its beneficiaries.  Because of this, the Centers for Medicare and Medicaid Services have begun penalizing hospitals with readmission rates higher than the national average for a particular disease state by decreasing reimbursement back to the hospital. The leading cause for readmission of these patients was attributed to a medication-related problem. A study conducted in Ohio looked to determine the impact that pharmacist intervention can have when implemented during transition of care.

Kroger pharmacies partnered with two small community hospitals in the Cincinnati area for patient referral as part of the TransitionRx program. At the time of hospital discharge, nurses counseled the patients on their medications with no input from pharmacists. Patients included in the study were aged 18 or older and diagnosed with either CHF, COPD, or pneumonia. Seven clinical pharmacists received training to provide MTM services with a special focus on counseling post-discharge patients. At the time of discharge, the hospitals faxed patient information, including discharge instruction and medications to the pharmacists at the designated Kroger locations. Pharmacists then made phone calls to these patients to schedule an in-person MTM session ideally within 3 days of discharge. During these appointments, the pharmacists provided a discussion of any changes in medication, a comprehensive medication review, and disease-state education, with a special focus on “red flags”. “Red flags” were defined as specific symptoms that patients could monitor for that could indicate their disease is deteriorating. Patients were provided with a personal medication record, health action plan, an appointment list, a self-monitoring log, if applicable, and a summary of the visit was sent to the patient’s physician. A follow-up was conducted via telephone.

90 patients participated in the study and 30 received the pharmacist intervention. Of the 60 patients that did not receive discharge counseling from a pharmacist, 20% were readmitted to the hospital within 30 days, while only 7% of patients in the intervention group were readmitted. Over 200 unique interventions were made by the pharmacists to the 30 patients that they saw, with 7 interventions per patient on average.

I enjoyed reading this article because the MTM sessions carried out by the pharmacists are extremely similar to what we have been learning to do in POP with standardized patients and with SilverScripts. It is encouraging to know that even as P1’s we are already preparing for our future careers and learning skills that will be essential to patient care in the future. Understanding Medicare STAR ratings and hospital reimbursements as the future of healthcare and realizing that patient health is the priority will help to develop a patient-centered approach as pharmacists. This article also highlights the need for pharmacists working with the interprofessional healthcare team and the benefits that can be provided. With just 7 participating pharmacists being able to identify over 200 drug therapy problems in 30 patients, the need for intervention is clear to see.

Reference:

J Am Pharm Assoc. 2015;55:246-254.

http://www.japha.org/article/S1544-3191(15)30055-8/pdf

Blood Pressure kiosks for medication therapy management programs

For one month, the total revenue collected by using blood pressure kiosks was generated and measured to identify how valuable kiosks could be in identifying hypertensive patients. Studies currently show that hypertension affects twenty to thirty percent of North American adults, and one-half of this hypertensive population remain uncontrolled. Uncontrolled hypertension leads to many adverse effects, some of which include heart failure, myocardial infarction, and stroke. By implementing blood pressure kiosks, patients may more easily obtain their blood pressure readings, and therefore find help from pharmacists if deemed necessary.

From this study, researchers concluded that on average, 189 hypertensive patients per month would qualify for a drug review and patient consult with a pharmacist. These reviews and consults would qualify for revenue collected. Overall, more than 7.5 million readings from 341 pharmacies were taken on the blood pressure kiosks. Through calculations, researchers determined by pharmacies could collect an average of $12,270 annually in revenue from MTM services provided to patients who discovered their hypertension. It is evident that blood pressure kiosks are very valuable in a pharmaceutical setting.

I found this article interesting because I myself have used a similar kiosk at a local pharmacy. Although I had already known that I was not hypertensive and I was merely just playing with the technology, I did wonder how beneficial the kiosk was to the company that I was in. From this study, I have no doubt implementing a blood pressure kiosk can help pharmacists generate more patients, thereby providing the assistance and improving patient outcomes.

 

Houle SK, Chuck AW, Tsuyuki RT. Blood pressure kiosks for medication therapy management programs: Business opportunity for pharmacists.. J Am Pharm Assoc. 2003;52:188-194.

http://japha.org/article.aspx?articleid=1044014#Methods