Quick Facts

There is a definate need for the services we can provide. Here is information regarding the impact medication therapy management/disease state management can have on health and economic outcomes. 

About the Patient MTM and DSM Program 

·         Program launched in July 2008 

·         Network of over 200 certified pharmacists at over 80 locations throughout North Dakota 

·         Currently providing a customizable diabetes management program to over 300 state employees 

·         Positive outcomes already shown in improving patient health 

·         Additional programs available that can be tailored to our clients needs 

·         Website offering a wide variety of valuable health and medication information, www.aboutthepatient.net 

·         Clinical Coordinator provides program oversight and administration to ensure an effective, consistent program 

·         Central data management software used by all network providers for data collection and claim submission

Health Care Costs in the United States 

• $2.1 trillion in 2006 and increasing 
• Prescription drug costs of $217 billion in 2006  
• • Even more was spent on treating problems caused by medication misuse 
  • Non-adherence to medications costs $75.6 billion annually 
• Costs associated with chronic conditions are increasing 
• • Diabetes, asthma, cardiovascular disease, and high blood pressure are the most prevalent 
  • THESE ARE PREVENTABLE COSTS!!! 

 About the Patient Diabetes Program Impact 

• Preliminary 9 month data analysis 
• Primary indicator (hemoglobin A1C) – 47% of patients initially not at goal 
• • 34% of those are now already at goal 
• Improvements also seen in % of patients meeting goals for cholesterol & blood pressure 
• Over 1 cost savings measure per patient 

Results from other programs 

• Annual savings from pharmacist led programs 
• • $725 direct costs and $1,230 indirect costs per patient for asthma management 
  • $918 to $1,872 per patient in various diabetes management programs 
  • $1,600+ per patient for anticoagulation services 
• ROI from various programs has ranged from 2:1 to 12:1 depending on costs included 
• One program resolved 5,780 drug therapy problems in 2,542 patients 
• Another program increased diabetic patients meeting goal from 42% to 57% 
• Cholesterol program increased those at goal from 33% to 69% 
• Blood pressure program increased patients at goal from 30% to 81% 
• Asthma program decreased missed workdays from 10.8/year to 2.8/year and ER visits from 9.9% to 1.3% 

Pharmacists are in a unique position to provide quality MTM/DSM programs 

• Accessibility – one of the most accessible health care professions 
• Knowledgeable - trained to provide MTM services 
• Trusted – always near the top of most trusted professionals in Gallup poll 
• Proven – numerous studies showing positive health and financial outcomes for pharmacist led programs 

 Pharmacists at the hub of health care collaboration 

• “Medication Home” – pharmacists are often reconciling medications from multiple prescribers

Program design is based on best-practices and Medicare Part D MTM requirements 

• Opt-out enrollment – has higher success rates than opt-in programs 
• At least quarterly communications with target beneficiaries 
• Target beneficiaries with multiple chronic conditions (2+) on multiple medications (2+) with annual drug costs of $3000+ 
• Contains an interactive component in addition to passive methods 
• • Either face-to-face (preferred) or via other methods 
• Continued monitoring and follow-up 
• Annual comprehensive medication review for all beneficiaries 

 Outcomes Measurements 

• Drug utilization 
• Beneficiary Health 
• Financial Impact 
• Customer Satisfaction 

 MTM Program Core Elements 

• Medication Therapy Review – the heart of the process 
• Education - of patient on wellness issues specific to their health 
• Intervention/Referral – to other health care professionals if needed 
• Action Plan – developed with the patient to empower them to self-manage their health 
• Personal Medication Record – reconciled list of all current medications 
• Documentation and follow-up – reports are shared with the patient and their primary physician to provide continuity of care 

About the Patient MTM/DSM Programs 

• Meet or exceed CMS guidelines 
• Certified providers 
• Broad access to providers 
• Central Administration, software, documentation, billing, and outcomes reporting 
• Auditable and transparent 
• Goal is to empower patient to self-manage and improve their health 

Custom Design 

• Member selection 
• • Screening of claims 
  • Medication Therapy Review for all members 
  • Opt-in vs. Opt-out 
• Program components 
• • Number/length of visits 
  • Interval between visits 
  • Length of program 
• Location of visits 
• • At provider, on-site, telephone, other 
• Member incentives 
• • Can increase participation and involvement 
  • Performance or attendance based 
  • “Wellness” credit 
  • Prescription co-pay reimbursement 
• Outcomes reporting 
• • Frequency of reports and data contained 
  • Surveys 
  • Clinical data 
  • Interventions made 
• Billing 
• • Centralized, monthly billing utilizing CPT codes 
  • One bill, one payment for all services 
• Reimbursement Options 
• • Flat fee per visit or per member per year 
  • Variable based on complexity 

Why implement MTM into your health benefits? 

• MTM has been shown to improve patient health and have a positive return on investment for sponsors 
• Preventing chronic complications saves health care expenses 
• Wellness programs are viewed by members as a valuable benefit 

Why use the About the Patient programs? 

• Our programs are customizable to meet your needs 
• We have access to a dedicated network of pharmacist providers 
• Many options are available 
• Central program administration removes much administrative burden from the plan sponsor 
• We have experience and have evidence supporting the positive impact of our program 
• Our “neutral” providers consider all aspects in health care decisions 
• Our programs are fully transparent and auditable 
• OUR FOCUS IS ABOUT THE PATIENT