Holistic review of medication therapy management unlocks results

It's been more than two decades since the term medication therapy management, or MTM, became etched into the healthcare landscape. Its goal was to leverage the role of pharmacists to optimize therapeutic outcomes and reduce unnecessary medical and prescription healthcare costs. 

Since its inception, patients are on more prescription drugs prescribed by providers who have less time to spend with them. It's clear that this close examination of individual prescription drug lists is more necessary than ever before. Unfortunately, many MTM programs do only that — examine a patient's prescriptions and counsel based on system-generated interactions and adherence. This simplified review inhibits the full potential of MTM, which can be more effective at improving outcomes and reducing costs to patients and employers with a focus on the whole person and their lifestyle.

As a pharmacist with more than 20 years of experience, I've seen firsthand the many ways a holistic review of medications can help when pharmacists have access to a patient's medical records, can review lifestyle behaviors and recommend changes while collaborating with the patient and his or her broader care team. Doing so can improve health outcomes, as well as save money and lives.

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If your clients aren't seeing these results and wonder how an MTM program can help, or their existing program can be more effective, I'd recommend asking the following questions:

Does the program encourage collaboration between the pharmacist, patient and healthcare team?

For MTM to be effective, pharmacists need access to collaborate directly with the patient, as well as his or her care team to determine if their medication protocol is appropriate, effective and safe. Due to our fragmented healthcare system, many patients receive care from multiple providers, specialists and facilities, along with disease-centric management and digital health programs. This leads to limited or no communication between stakeholders, as well as disjointed medical records. 

While electronic health records have improved communication between many of these stakeholders, it's rare that a pharmacist is able to see a patient's complete health history. Additionally, MTM requires collaboration from the patient's employer and provider to share eligibility and participation information, since many patients are unaware that they qualify for MTM assistance, or even how they would benefit. 

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Does it include time for follow up?

Providers are under-resourced and overscheduled, allowing limited time to interact with patients and other members of the care team. Pharmacists encounter the same challenges when faced with increased responsibilities and staffing levels that can't meet demand. A practice like comprehensive MTM requires more efficient use of time in order to make an impact. Dedicating time to effectively assess a patient's medications and provide needed check-ins to promote follow-through on the nuances of recommendations is critical,  necessitating a shift away from volume-based MTM targets. Additionally, it's important to allocate time to find patients who are typically left out of MTM program recommendations — a process that can be made more effective than the current set of standard criteria with enhancements in machine learning and AI.  

Does it address a patient's lifestyle factors?

Despite patients' frequent touchpoints within the healthcare system, they can feel lost or confused about how to manage their health, and the why and how to follow medication directions from their provider. I often talk about the "medication management gap," which we work to fill by providing patients with one-to-one coaching that integrates lifestyle and health factors that play a significant role in medication need, effectiveness, safety and overall successful use. Our pharmacists not only coordinate with lifestyle guides, but directly with a patient's care team to limit confusion. Sufficient time for direct and frequent patient and care team interaction has led to impressive results in both health outcomes and reductions in medical and pharmacy utilization, such as a 15% average reduction in prescription drug use among our population.

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Pharmacists realize the significant potential MTM has to enhance health outcomes and reduce healthcare costs by optimizing medication use and leveraging lifestyle improvements to achieve health results. However, several obstacles common in our volume-driven healthcare system can hinder its effectiveness. Addressing these challenges requires a multi-faceted approach involving integrated healthcare systems, collaborative care teams, increased time spent with patients to sustainably address lifestyle improvements, and improved access to and delivery of comprehensive MTM programs.

By acknowledging and proactively tackling these limitations, other healthcare providers, employers and policymakers can work alongside clinical pharmacists to enhance the impact of MTM programs, leading to improved patient health and reduced healthcare expenditures. Taking a closer look at MTM programs and what they offer can produce positive returns for the bottom line, and more importantly, the lives of the employee populations you serve.