CMS pilot extended to Part D MTM in 2017
A new, long-term pilot program from the U.S. Centers for Medicare and Medicaid Services’ Center for Medicare and Medicaid Innovation, set to launch in 11 states in January 2017, will gauge the effectiveness of an Enhanced Medication Therapy Management model.
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The program will include sweetened payments and other incentives to the Part D plans that “offer innovative MTM programs, aimed at improving the quality of care while also reducing costs,” according to CMS. The agency called the five-year effort to boost MTM services and evaluate their impact on patient outcomes and costs part of its “better care, smarter spending, healthier people approach to improving health delivery.”
Five Part D regions will participate in the pilot, encompassing 11 states, including Arizona, Florida, Iowa, Louisiana, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Virginia and Wyoming.
The long-term goal, according to CMS, is “to test whether providing Part D sponsors with additional payment incentives and regulatory flexibilities will engender enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures.”
CMS called the program “an opportunity for stand-alone basic Part D plans to right-size their investments in MTM services, identify and implement innovative strategies to optimize medication use, improve care coordination and strengthen system linkages.”
In a statement aimed at Medicare beneficiaries, CMS urged seniors to take advantage of MTM services if they’re offered by their Part D drug plan. Among the benefits “a pharmacist or other health professional” can provide through MTM, the agency tells beneficiaries, and “a comprehensive review of all your medications,” as well as counseling on:
- How to get the most benefit from the drugs you take
- Any concerns you have, like medication costs and drug reactions
- How best to take your medications
- Any questions or problems you have about your prescription and over-the-counter medication.
MTM also includes “a written summary of this discussion, including an action plan that recommends what you can do to make the best use of your medications,” CMS reports, as well as “a personal medication list that will include all the medications you’re taking and why you take them.”
Investing in pharmacy services
One factor behind CMS’ more aggressive push to promote a more hands-on, direct style of care for Medicare patients is the relatively sluggish adoption of the MTM concept by Part D prescription drug plans, according to Larry Kocot, former VP government affairs for the National Association of Chain Drug Stores, and currently head of KPMG’s new Center for Healthcare Regulatory Insight within its Healthcare and Life Sciences Practice.
“For a variety of reasons, MTM has not realized its potential in Medicare Part D,” Kocot told DSN. “Most Part D sponsors do not view MTM activities as central to their patient care strategies because incentives are not aligned sufficiently to drive them to look beyond MTM as a program requirement.”
“Indeed, MTM in Part D is currently included as an ‘administrative cost’ within Part D bids,” Kocot added. “As a result, plans actually have an incentive to economize on MTM to control costs, rather than invest in MTM to optimize therapy. By realigning the incentives and paying plans for MTM outside of the bid, CMS is trying to unleash the potential for advances in MTM to more directly benefit beneficiaries and the Medicare program.”
To spur innovation, improve long-term patient outcomes and encourage adoption of MTM, said Kocot, “the first step is to realign the incentives.” CMS’ new pilot program, he said “will test whether the incentives are sufficient to achieve the goals of the program.”
“The exciting part of this demonstration model is that CMS will be developing direct and useful evidence to apply to continually improve the program,” he noted. “With incentives realigned and plan sponsors leveraging the important role of pharmacists within the program, MTM may actually become a cornerstone of the Medicare Part D benefit.”
Pharmacy groups quickly embraced CMS’ plan. “NACDS and our allies know that MTM can go a long way toward helping patients get and stay healthy, and toward addressing the $290 billion in annual costs that are associated with not taking medications as prescribed,” said Steve Anderson, president and CEO of NACDS. “That is why NACDS is advocating for the Medication Therapy Management Act [S. 776], and … for MTM programs in the Affordable Care Act.”
“We want to identify exactly how this fits into a comprehensive vision to help patients benefit from MTM — particularly those patients who have the most to gain from improved medication use,” Anderson added.
The renewed impetus for pharmacist-provided MTM services comes amid growing support in Congress for a higher level of pharmacy-based patient care, according to the Patient Access to Pharmacists’ Care Coalition, an advocacy group whose members include NACDS, the National Community Pharmacists Association, the American Pharmacists Association and the National Alliance of State Pharmacy Associations. That support is seen in the steady rise in the number of lawmakers who have added their names to the Pharmacy and Medically Underserved Areas Enhancement Act (S. 314/H.R. 592), a piece of legislation that would expand Medicare beneficiary access to pharmacist-provided patient care services in medically underserved communities.
“Cosponsorship in the House of Representatives recently eclipsed 230, confirming that a majority of House members recognize the value that pharmacists can play in providing healthcare services to underserved communities throughout the nation,” PAPCC reported in early November. “The Senate’s support is also strong, with cosponsorship now equaling 33 [senators].”
Prescription home delivery service options increase
The advent of online shopping and the proliferation of mobile apps across a wide range of businesses has led consumers across the country to expect companies that provide them with goods and services to deliver products to their door.
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While Amazon has set the standard for this new way of shopping — offering same-day delivery of thousands of items in some markets for Amazon Prime members — a handful of smaller companies are beginning to explore ways to deliver prescriptions.
Major pharmacy chains like Walgreens, Rite Aid, CVS/pharmacy and a host of others have offered home delivery in some markets for several years, and independents across the country tout such services as one of the factors that set them apart from their competitors. However, the most recent entries in the prescription delivery business have upped the ante, promising patients quicker service that fits their schedule.
In New York City, for example, Zipdrug, a startup that debuted in July, is offering on-demand prescription delivery from any pharmacy in Manhattan and expects to widen its reach in the New York area by the end of the year, as well as start exploring other markets in 2016. The company uses HIPAA-trained, background-checked and drug-screened messengers to ensure patients’ privacy and safety.
Zipdrug founder Stuart Libby told Drug Store News earlier this year that his service takes the guess work out of prescription delivery, bolstering retailers’ reputations and driving patient adherence.
“Instead of sending out a messenger where you don’t know what time the medications will arrive — if they did arrive — and there’s a paper confirmation from the patient, we digitize all of that and make it really easy, accountable and transparent, which ultimately will lower costs and help increase adherence for pharmacies,” he said. “Waiting for your prescription medication shouldn’t be like waiting for your cable installation. It should have a precise time that you know it comes.”
Meanwhile, in San Francisco, two companies — ScriptDash and TinyRx — offer slightly different forms of prescription delivery.
ScriptDash bills itself as an actual pharmacy that provides free on-demand delivery to a home or office within two hours of receiving the patient’s prescription. TinyRx is more of a traditional delivery service, partnering with independent pharmacies to bring medications to patients’ doors. The company said it uses a prescription coupon index to ensure that patients pay the lowest price for their medicines.
“Even with insurance, we often save customers hundreds of dollars per year,” TinyRx said on its website.
As the demand for home delivery increases, systems and software suppliers have begun exploring ways to help community pharmacies incorporate these services into their everyday offerings.
Earlier this year, for example, QS/1 released QS/1 Delivery-Rx, an Apple iPad application for prescription medication delivery that does not require an Internet connection or cellular signal.
Market analyst Justin Buckland said the app — designed to work with the company’s NRx Pharmacy Management System and Point-of-Sale software — lets pharmacies download transactions, capture signatures, accept payments and allow deliveries from multiple stores.
“Customer service is the backbone of independent pharmacies,” he said when the app was rolled out in October. “This new app allows pharmacies to show their commitment to top-notch customer service and place themselves ahead of the competition.”
While it was originally developed for retail pharmacies, Buckland said QS/1 is looking at modifying QS/1 DeliveryRx so it can be used in long-term care pharmacies, as well.
Solutions like this, he said, are the first steps in what many see as the next wave of innovation in pharmacy technology, as retailers look to keep up with customer demands for new options and a more comprehensive pharmacy offering.
“I expect it to be a huge resource for local pharmacies as it makes it much easier to manage the delivery process,” Buckland said. “I expect some pharmacies to take advantage of it as part of their customer service.”
Digital tools, automation streamline Rx process
As health care in the United States continues to shift from a system based on services to one where providers are rewarded for driving outcomes, an efficient pharmacy operation and the ability for pharmacists to spend time with patients is more critical than ever.
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To meet these goals, pharmacies large and small are turning to sophisticated technologies that can streamline the prescription-filling process, maximize workflow and ultimately free up pharmacists to counsel their patients. A report released in May by the forecasting firm Markets and Research estimated that the North American pharmacy information system market will increase by slightly more than 8% a year through 2019.
“The changing healthcare landscape requires pharmacy to adapt to a new model that not only focuses on filling prescriptions, but also places a premium on what happens to the patient using those medications,” said Frank Sheppard, president and CEO at Ateb, a provider of pharmacy-based patient care solutions.
“Pharmacy already has the data and resources to address this model,” he said. “It simply must adopt incremental changes to better leverage its existing relationships with payers, physicians, health systems and patients to improve patient health outcomes.”
Ateb’s Patient Management Access Portal, for instance, allows pharmacies to identify patients who can benefit from improved pharmacy engagement and communication, while its Time My Meds medication synchronization solution helps drive medication compliance and adherence.
Other technology suppliers have taken their offerings in a similar direction, offering a variety of tools to pharmacies and their patients, including systems that can improve workflow, enhance medication therapy management programs and streamline the prescription-filling process.
“We believe that automation, mobile technology and interfaces will allow our customers to be more efficient, while improving patient experience by decreasing wait times and allowing more personal service,” QS/1 market analyst Jon Bell said.
For instance, he noted, the company’s unique InstantFill automatically queues interactive voice response (IVR) and Web refills, and prints labels; its Health-Minder automatically fills routine prescriptions and can call, text or e-mail pickup reminders to patients; and its RetrieveRx will-call bin management and point-of-sale systems help pharmacies minimize waits at checkout.
For MTM programs, QS/1’s Patient Chart and Patient Outcome records can document changes to a patient’s medication history and record the results of an intervention.
Technology providers say that because pharmacies have access to so much patient data, they are in the ideal position to take on a greater role in patient care.
“Pharmacies have a tremendous amount of data that can be mined to provide a virtual road map for viewing which patients are at risk and which strategies the pharmacy can implement to help these targeted patients.” Ateb’s Sheppard said. “By converting their pharmacy practices to a proactive workflow, pharmacies are able to predict when patients on chronic medications will visit the pharmacy for their prescription refills, thereby allowing pharmacies to manage their inventory better, and prepare in advance for a productive patient encounter.”
Those who offer pharmacy technology say that nothing is more important to meeting the demands of the evolving healthcare system than an efficient workflow. Better workflow, they say, results in increased patient engagement and improved outcomes.
“In the past 20 years, we’ve gone from workflow not even being a term used in pharmacy to a very important part of the process of any pharmacy,” said ScriptPro president and CEO Mike Coughlin, whose company has supplied pharmacies with robotics and other pharmacy technologies since the mid-1990s. “One of the greatest factors in improving that workflow has been pharmacists’ confidence in the technologies they are using.”
With many pharmacists and pharmacy executives today having spent their entire careers working in computerized pharmacies, the comfort level has never been higher, he said. As a result, community pharmacy operators have become more open to these systems and are adding them to their stores.
“The people who have been on the sidelines are now starting to see the benefits and saying they should have done it sooner,” Coughlin said, noting that a robot to automate the prescription process has been shown to provide significant savings in the long term. While the upfront cost of such a device can be substantial, he said, on average, robots handle between 40% and 60% of a pharmacy’s prescriptions and cost just $25 a day to operate.
As the role of the community pharmacist continues to change, so do the types of drugs they are being required to dispense. Technology providers say the growing use of specialty drugs is leading to new software to ensure these drugs are prescribed correctly and used safely.
“Drugs today can do tremendous things,” Coughlin said. “But now more than ever, they need to be used correctly. It’s not good enough any more to give the patient the right drug. They have to ensure they are used properly or there could be dire consequences.”
Because of that, he noted, using a pharmacy system that scans the pill or tablet and lets the pharmacist or technician view a prescription at every step of the dispensing process is critical. Just as important, those in the industry say, is a detailed drug utilization review function.
Going forward, technology will continue be a vital part of America’s pharmacies, taking on new roles and being applied to other areas of the business. Coughlin, for instance, said the day is not far off when robotic automation could be applied to will-call and other pharmacy-related areas.
Others echo that sentiment, saying that while technology has enabled pharmacy to adapt to the changing dynamics of the country’s healthcare system, it must continue to evolve to meet the challenges that lie ahead.
“Pharmacy is in the right place at the right time with the right resources available to be a major contributor to addressing the challenges of delivering effective, affordable health care,” Ateb’s Sheppard noted. “We have developed the tools, data models, intellectual property and business processes to allow pharmacy to capitalize on this opportunity to be a leader in patient engagement and patient care delivery.”
However, he stressed, community pharmacy is only one cog in the wheel. A comprehensive team of healthcare providers all employing sophisticated systems to drive patient outcomes is the future of American health care.
“Pharmacy will not replace the network of skilled physicians that patients rely on for their care,” Sheppard said. “However, pharmacy should develop the capabilities to integrate into the existing healthcare system by leveraging its unique opportunity: the ability to engage patients regularly about their healthcare concerns and outcomes.”