Special FeatureClinical and economic outcomes of medication therapy management services: The Minnesota experience
Section snippets
Objectives
The objectives of this evaluation project were to: (1) provide MTM services to patients, (2) measure the clinical effects associated with the provision of MTM services, (3) measure the percent of patients achieving Healthcare Effectiveness Data and Information Set (HEDIS; formerly Health Plan Employer Data and Information Set) goals for hypertension and hyperlipidemia in the MTM services intervention group in relationship to a comparison group that did not receive MTM services, and (4) compare
Methods
This article reports data from a 1-year prospective study of an MTM services intervention group and a 1-year retrospective period that served as a historical control. Patients receiving MTM services were continuously enrolled, with a health insurance benefit provided by BlueCross BlueShield of Minnesota (BCBSM). Institutional review board oversight and approval occurred through the University of Minnesota Human Subjects Protection Program, and informed consent was obtained from patients.
Results
A total of 285 patients received MTM services in the intervention group (188 women and 97 men; 40 patients [14%] 65 years of age or older), and a total of 684 MTM encounters (2.4 per patient) occurred during the 1-year study period.
Discussion
This study evaluated the outcomes of MTM services provided to a group of high—resource-use patients included in an MTM health benefit design. The percentage of patients meeting selected HEDIS criteria was higher in the intervention group. The percentage of patients’ goals of therapy achieved and the number of drug therapy problems resolved in intervention group patients are consistent with previous studies in which comprehensive MTM services were provided within the practice of pharmaceutical
Limitations
This study and the generalization of its results are subject to the following limitations: (1) selection bias influencing use of the MTM services benefit by patients; (2) selecting the MTM group of patients based on high health resource use, high health care expenditures, or complex drug therapy needs; and (3) using insurance payment claims to measure total annual health expenditures.
First, patients with pressing medical care concerns and drug-related needs may be more likely to use MTM
Conclusion
This practice-based research project combined the interests of an academic health center, integrated health care system, and health insurers to study the outcomes of face-to-face MTM services. MTM services address drug-related morbidity and mortality by creating a process for ensuring the safe, effective, and appropriate use of medications. This study provided evidence that pharmacists working in collaboration with primary care providers identified and resolved drug therapy problems in a manner
Twelve medical conditions included in the study:Identification of medical conditions using ICD-9-CM codes or generic code numbers for prescription drugs
Medical conditions were identified from facilities and professional claims using ICD-9-CM codes published in The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Certain medical conditions were identified by from prescription claims using Generic Code Numbers (GC3 codes) reported in the National Drug Data File (NDDF) published by First DataBank (Hearst Publishing Co.). The following is a list of medical conditions included in this study with the
Classification and grouping of insurance claims by place of service for Blue Cross Blue Shield of Minnesota
The BCBSM facilities claims for study subjects were grouped by place of service as follows:
- (1)
hospital inpatient [X-ray, laboratory (excludes allergy), consultation, hemodialysis, surgery, assistant surgeon, Durable Medical Equipment (DME) rented supplies, other supplies, anesthesia, medical visit, allergy services, injectables (excludes chemotherapy/allergy), immunizations/vaccines, chiropractic, room & board, physical therapy, other ancillaries, psychotherapy, radiation therapy, drugs];
- (2)
hospital
References (46)
- et al.
CPT code-change proposal: national data on pharmacists' medication therapy management services
J Am Pharm Assoc.
(2007) Definition of medication therapy management: development of professionwide consensus
J Am Pharm Assoc.
(2005)- et al.
The Asheville Project: short-term outcomes of a community pharmacy diabetes care program
J Am Pharm Assoc.
(2003) - et al.
The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program
J Am Pharm Assoc.
(2003) - et al.
Quality improvement in chronic illness care: a collaborative approach
Jt Comm J Qual Improv.
(2001) Building the business case for quality improvement
J Am Pharm Assoc.
(2005)- et al.
Effects of collaborative drug therapy management on patients' perceptions of care and health-related quality of life
Res Social Adm Pharm.
(2006) - et al.
Quality of pharmaceutical care in hospitals
Am J Hosp Pharm.
(1975) - et al.
Levels of pharmaceutical care: a theoretical model
Am J Hosp Pharm.
(1991) - et al.
Quality assessment of a collaborative approach for decreasing drug- related morbidity and achieving therapeutic goals
Arch Intern Med.
(2003)
Report to the Congress: Medicare coverage of nonphysician practitioners
Current Procedural Terminology: CPT 2006
Current Procedural Terminology: CPT 2008
an insider's view
Chicago: American Medical Association;
Pharmaceutical care services and results in Project ImPACT: Hyperlipidemia
J Am Pharm Assoc.
A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP)
Arch Intern Med.
Pharmacists' ability to influence outcomes of hypertension therapy
Pharmacotherapy.
Implementation of pharmaceutical care services for patients with dyslipidemias by independent community pharmacy practitioners
Ann Pharmacother.
Pharmacist participation on physician rounds and adverse drug events in the intensive care unit
JAMA.
Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units
Arch Intern Med.
Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs
Arch Intern Med.
Cited by (298)
Impact of updated hypertension guideline on eligibility for an employee wellness program
2024, Research in Social and Administrative PharmacyPolypharmacy in chronic kidney disease: Health outcomes & pharmacy-based strategies to mitigate inappropriate polypharmacy
2024, American Journal of the Medical SciencesPatient-centered medical home pharmacists’ impact on composite quality care measures for patients with uncontrolled type 2 diabetes
2023, Journal of the American Pharmacists AssociationA descriptive analysis of primary care providers' interest in clinical pharmacy services
2023, Exploratory Research in Clinical and Social Pharmacy
Disclosure: Dr. Cipolle has an equity interest and serves on the Board of Directors for Medication Management Systems, Inc., the company licensed to distribute the Assurance pharmaceutical care documentation system used by pharmacists in this study. The other authors declare no conflicts of interests or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.
Funding: This project was supported by a grant from the University of Minnesota–Academic Health Center/Fairview Health System Joint Funding Program.
Acknowledgments: To Bruce Lindgren and Dorothee Appeli, Biostatistics Consulting Laboratory, University of Minnesota, for providing advice on the statistical analysis; and Nancy Hardie, Program Analyst and Richard Pham, Graduate Program in Health Informatics, University of Minnesota, for database management and analysis; and to Amanda Brummel, Kerry Close, Molly Ekstrand, Mike Frakes, Carolyn Kilgore, Nicole Paterson, and Paull Rukavina, pharmaceutical care practitioners, for ensuring the integrity of informed consent and providing care to patients.
Previous presentation: Preliminary project results presented at the BlueCross BlueShield Association Best Practices in Medical and Pharmacy Management Meeting, October 9, 2003, Chicago.