There is a definite 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