Monday, January 28, 2013

Forget MTM, I'm doing PPC

Medication therapy management.


That's been the focus of the pharmacist organizations for the past several years.  The thought of pharmacists providing direct care to patients in an effort to improve the health of the patient, as well as decrease the health care expenditures for both the patient and the third-party payer.

In my state, as well as many others, the focus of medication therapy management has been the Medicare patient.  Those who have already reached "retirement".  When Medicare Part D was introduced, the idea of providing direct care to patients via comprehensive medication reviews made many pharmacists happy.  But as the years have passed, we've seen that not all Medicare D patients are eligible for the CMRs.  Only the patients who meet insurer-defined criteria have been eligible to receive these services from pharmacists.

Shortly after providing my first comprehensive medication review for a Medicare D patient, I realized that the focus of pharmacist-provided care shouldn't be on the Medicare D population.  These people are already well into their disease processes.  Sure, we may be able to help educate these patients and help slow the progression of their health problems.  But if we want to show the value of pharmacist-provided care, we need to change our focus.

We need to educate the younger patient.  The 30-somethings who are being started on statins.  The twenty-somethings who have been diagnosed with type-II diabetes.

I was pleased to see that the recent petition to recognize pharmacists as providers received the required amount of signatures.  Provider status from Medicare will get the ball rolling for pharmacists as a profession.  But we shouldn't wait around for CMS to act.

We need to take it to the local insurance companies.  To the local employers.  Sell the idea of pharmacist-provided care to the people in your community.  If you generate a local buzz, people will take notice.

Go to the local self-insured employer.  Talk with them about how pharmacists can help decrease their medication expenses.  Talk with them about how medication adherence can reduce other health-care expenses.  Remind the employer that you can help employee be more productive during their work day.  Teaching that diabetic employee about how to better control their blood sugar may increase their productivity by two hours each day.  No more early afternoon blahs because the blood sugars are out of whack.

The profession has created a little bit of buzz about pharmacist care lately.  Let's not let the momentum die as we wait for CMS to act or not. 

Personally, I'm not going to use the term "medication therapy management" when I go out and talk about these services.  Mostly because my state requires collaborative practice agreements to actually "manage" the patients' medications.  I'm going to simply use the term "pharmacist-provided care". 

MTM keeps the focus on the medication.

PPC puts the focus on the pharmacist.  The pharmacist as the provider.  The pharmacist as the care-giver.  Because folks, it's not all about the medication.  It's about the knowledge that the pharmacist has that will make the difference in the health of our patients.  Medications are simply one tool that we may use.

We can impact the lives of our patients.  Let's not wait until they reach retirement age.  Let's roll PPC out to the younger patient and make the difference in their health that we know that we can.


ketzazu said...

That's an interesting shift to tap into the vast theoretical knowledge we amassed in pharmacy schools. Besides, the current model of working for one the big chains no longer because there are too many pharmacists to fill those scarce positions. We pharmacists must regroup and refocus in order to save the pharmacy profession and guarantee us a job for add long as we can practice.
Thanks for your leadership in the topic.
Abner Cesaire, Rph.

HuggyBear said...

I strongly agree with your sentiment about Pharmacist Provided Care. It would have made a lot more sense than "MTM," which as a concept is more PC (read: politically correct) and less needed than PPC. If "MTM" hadn't already become the widely accepted jargon, I would change the name of my practice in a heartbeat.
Adam Oderberg, PharmD
Tandem MTM

Ronald Lavine, D.C. said...

I support your efforts to offer quality care to patients. Pharmacists have a potentially important role to play. If a patient of mine has a question about a prescription, I always suggest they speak with their pharmacist - a pharmacist will know more about drug side-effects and interactions than a typical primary care MD. But many people think of their pharmacist as being totally generic - just a nerdy uncaring person in a white coat. It shouldn't/needn't be that way.

Dept. of Pharmacology said...

I've been involved in the training of pharmacists for over 15 years now, and have been privileged to observe the (albeit slow) transformation of the pharmacist from simply a commodity provider to a service provider and, more recently, to a care provider as part of the healthcare team.
It has been a real paradigm shift, and one that we have incorporated and continue to emphasize in our training.
Great post Eric.