Medication Therapy Management Implementation Supports Million Hearts Goals

Submission Date: May 2016

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Connecticut

States/Territories Involved: Connecticut

Funding Source: NACDD

Other Funding:

NACDD funding

Domain Addressed:

Health Systems Strategies

Public Health Issue:

• High blood pressure and diabetes, major contributors to heart disease and stroke, are usually treated with one or more prescribed medications and medication-related problems are common.
• Medication therapy management (MTM) services by a pharmacist – services beyond simply filling a patient’s prescription – can result in significantly improved outcomes in disease management, quality of life measures or cost savings as demonstrated in over 300 studies.
• But barriers exist in the effort to integrate pharmacists into the health care team. For example: pharmacists have limited access to health information systems; medical professionals and potential beneficiaries lack awareness of the benefits of MTM; and pharmacist MTM is not widely reimbursable as a direct, patient-care service.

Project Objectives:

The objective of the Connecticut Department of Public Health Community Pharmacy Initiative is:

• To Increase the engagement of community pharmacists in the provision of medication self-management for adults with high blood pressure and adults with diabetes

Objectives of the Million Hearts Stakeholder workshop were to:

• Discuss the National Million Hearts® initiative and the role of MTM in supporting Million Hearts® goals
• Discuss the definition and components of MTM and learn about application of MTM models in Connecticut
• Discuss the role of pharmacists, providers, payers, and policy makers in implementing MTM, as well as explore successes, barriers, and opportunities

Program Action:

• The University of Connecticut School of Pharmacy (CSP) and Connecticut Department of Public Health (CDPH) partnered to work on MTM as part of the CDPH Community Pharmacy Initiative. This initiative is a focus of CDPH’s Million Hearts efforts. Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes by 2017.
• CSP developed a pilot project on MTM for patients with high blood pressure and diabetes with support from CDPH. Patients are counseled by MTM-trained pharmacists on disease management and self-care strategies and pharmacist works with patients’ primary care providers to manage medication. CDPH provides data analysis and raises awareness on the importance of MTM among state providers and other stakeholders.
• CDPH and CSP with support from the National Association of Chronic Disease Directors conducted a Million Hearts® workshop with Connecticut stakeholders such as pharmacists, employers, payers, clinical representatives, organized medical groups, and hospital and public health representatives, to raise awareness of the role of MTM in combating heart disease and stroke and engage stakeholders in brainstorming ideas on how to establish and sustain MTM services through private health insurance. Details are available in a 5-page issue brief on the Connecticut MTM initiative.
• Connecticut is also engaged in work on health care access and identification of opportunities for sustainable financing of MTM services through engagement with Medicaid, the state insurance exchange, State Employee Health Plan, and State Office of Health Reform & Innovation. Current sustainability initiatives include legislation (not part of 1305) to allow a credentialed pharmacist to be a Medicaid provider for complex patients.

Data/Other Information Collected:

An adherence assessment was conducted using 2 methods:

• PDC values through Rx database screen
• Pre/post Modified Morisky Survey (behavior)

Data is collected on required CDC performance measures as well as others, as follows:
CDC required measures-

• Adherence to HTN/DM medications, availability of patient self-management plans, and assessment of patient’s A1C (< 9%) and blood pressure goal (JNC VII).

Other measures-

• Self-management assessment, adherence to recommended vaccine schedule; status of intervention/resolution of medication-related problems, and primary/secondary prevention medication assessment

Impact/Accomplishments:

• The Connecticut Million Hearts work advances national Million Hearts goals by:
  • Helping Connecticut meet performance measures for their CDC-funded 1305 grant, namely, “the proportion of patients with high blood pressure and/or diabetes in adherence to medication regimens”
  • Implementing a key strategy of Live Healthy Connecticut, the state’s coordinated chronic disease prevention and health promotion plan
• Results of the MTM pilot revealed important factors that promote effective MTM programs which will be applied to guide the work with additional pharmacies.

Challenges/Lessons Learned:

Challenges & lessons learned from the MTM Pilot include:

Challenges

• There are space, scheduling & time constraints in pharmacies & business model changes may be necessary. Pharmacists are willing to do this because it generates loyalty to the pharmacy.

Lessons learned

• Blood pressure logs were very effective for BP medication adherance.
• Use of Morisky Questionaire & Beliefs About Medicine Questionaire was effective.

In relation to sustainability of MTM Service:

• Credentialing is key for providers/payers
• Developing a community pharmacy network is helpful
• Underserved populations have highest health costs, complex med regimens, fragmented access to care & therefore the greatest potential for high ROI for these services
• The state’s Collaborative Drug Therapy Management Authority may assist in payer acceptance

Next Steps:

The Connecticut Department of Public Health plans to expand MTM to other areas of the state. CDPH is working with their Medicaid agency through several pharmacy champions, engaging in conversations on Medicaid’s plans related to MTM and the availability of medication adherance data directly from pharmacies. The pharmacy champions are engaged in ancillary activities, such as working with legislators to enact laws that support pharmacists as an integral part of the care team.

Program Areas:

Heart Disease and Stroke

State Contact Information:

CT
Mehul Dalal, MD, MSc, MHS
Department of Public Health
860-509-7611
mehul.dalal@ct.gov

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