The migration from product-focused to patient-focused is propelling the pharmacy profession forward. With the progression, we’ve also born witness to the increasing efficacy and importance of medication therapy management (MTM) programs.
Determining who should manage said programs is just as complicated of an issue. For any health plan who has attempted this feat themselves, they’ll tell you how challenging it is to hire, train, and retain a full staff of clinical pharmacists squarely focused on delivering comprehensive medication reviews to a diverse set of patients – especially if those patients possess low health literacy, speak a foreign language, or lack the cognitive ability to converse with a pharmacist. And that doesn’t include the challenges and incurred costs of building and establishing the sophisticated technology needed to run an effective and measurable program. Even those health plans with the best intentions struggle to drive positive member experience, deliver improved health outcomes, increase adherence, and drive overall member satisfaction.
Compounding the challenges, we’ve seen the cost of medication rise over the last few decades. For most Americans, including Medicare beneficiaries, the cost of obtaining much needed medications is simply becoming too expensive. The epidemic of chronic illness is only furthering the need for costly medications, with more Americans than ever suffering from one or more conditions including heart disease, diabetes, depression, HIV, and a myriad of others. Health plans must methodically rethink their approach from reactive towards proactive care to prevent future health issues.
For health plans looking to mitigate costs and improve efficiencies and outcomes, a trusted clinical pharmacy partner can help. In fact, outsourced MTM programs can help health plans manage costs across medication therapy management, medication adherence, and medication reconciliation programs.
In the era of skyrocketing rates of chronic disease and increasing medication costs, health plans find themselves faced with the challenge of increasing patient engagement to maximize their pharmacy and medical spend per member. Considering the challenges associated with standing up an MTM program from scratch, what is a health plan to do?
How outsourcing MTM leads to healthier members
Possibly the biggest benefit of MTM program outreach? Improved member satisfaction and subsequent health outcomes.
More than 30% of members stop taking their prescribed medications earlier than instructed. In fact, around 75% of adults in the United States struggle with medication adherence in one or more ways. Part of the reason for this is the legacy model in which many MTM consultations are delivered in-person at pharmacies. Advances in telehealth technology have paved the way for a new frontier of consultations, done virtually, where a member simply needs to answer their pharmacist’s call. Gone are the days of an overworked pharmacist delivering a distracted, disingenuous experience from behind a bustling counter. For health plans intending to positively impact the health of their members, outsourcing your MTM program to a proven partner is the first step. The most effective partners leverage the power of clinical pharmacists to educate and engage members during personalized consultations. We know that member education is key to improving medication adherence, and pharmacist-led consultations are the perfect vehicle for it.
Giving members the option to work with a pharmacist over time helps eradicate some of the systemic issues health plans face in keeping their members healthy. Having clinical pharmacists work with members directly and consistently fosters relationships built upon trust. In fact, 81% say they trust a pharmacist to diagnose minor illnesses and prescribe medications to treat them. Stronger relationships between pharmacists and their patients have also been shown to improve education and lead to improved levels of medication adherence.
The link between outsourcing MTM programs, improved medication adherence, and member well-being
Many people have difficulty understanding and following their drug therapy regimens. The Institute of Medicine reports that over 90 million people identify with having difficulties following a drug treatment plan. That’s just one reason medication non-adherence rates are so high.
When it comes to improved outcomes derived from MTM programs, health plans would be remiss to overlook the importance of medication adherence. MTM is a powerful tool for identifying barriers to adherence that can be caused by myriad factors such as lack of transportation, financial hardship, lack of health literacy, and forgetfulness, to name only a few.
No matter the cause, pharmacists have the necessary tools at their disposal to cure the nonadherence epidemic. They’re to empathetically connect with members, educate them in terms they understand, and create actionable plans to affect positive change.
To help improve outcomes and medication adherence, health plan members need a clinical pharmacist they can trust and feel comfortable with. To this end, outsourced MTM programs should focus on increasing engagement by matching members with MTM pharmacists that have a relevant specialty, share common geography, and have the same native language.
Beyond their extensive knowledge of drug efficacy and contraindications, experienced MTM pharmacists serve as patient advisors, providing ongoing support and education. This approach leads to strong relationships and improved member health. Creating meaningful relationships is one of the primary strengths of the Aspen RxHealth platform. And that’s critically important, because 95% of members say their lives and well-being have improved through an effective MTM program. Matching pharmacists and patients based upon a variety of clinical and social data enables us to provide the best possible pharmacist to every member, giving them the highest likelihood of receiving exceptional care.
Better Star Ratings, increased reimbursements
Member satisfaction and quality of care are important factors in the Medicare Star Rating system. The system was implemented to show how Medicare Part D and Medicare Advantage health plans perform across different categories that illustrate their commitment and efficiency in delivering care to their members. However, over time, Star Ratings have evolved. They’re now a major driver of health plan profits, and they’re becoming harder than ever to achieve. It’s for that reason that health plans can no longer afford not to take a laser-focus on optimizing their members’ medication use, and subsequently, their Star Ratings.
The CMS star system rating changed because of COVID-19. In 2021, out of 400 plans rated, only 21 received the elusive 5-star rating, with 63 achieving 4.5 stars. Increasing difficulty to achieve coveted 4- and 5-Star ratings has even spurred some industry giants to take up litigation against CMS to reinstate rules of the past that allowed them to achieve their goals more easily. This situation illustrates how challenging it is becoming to achieve a 4.5- or 5-star rating. Given the headwinds health plans face, they must consider using every tool available to drive ratings and ultimately reimbursement.
While Star Ratings are based upon numerous criteria, some of the most impactful efforts are those in the clinical pharmacy space. Medication adherence directly influences several Star Measures that are intended to gauge health plans’ management of medications in their chronically ill members. By outsourcing clinical pharmacy services and improving member medication adherence, health plans position themselves for Star Rating improvement. Not only do higher Star Ratings result in higher bonus payments from CMS, but health plans can then reinvest those funds to enrich member benefits, further bolstering member affinity and loyalty.
Reduce costs associated with MTM programs
It’s no secret that implementing a new medication therapy management program is costly. From staffing costs to the technology and IT infrastructure, the price can balloon out of control quickly. The right MTM vendor will not only perform high-quality services for your health plan but do so in a cost efficiency and value-based manner.
Relying on a trusted partner to manage clinical pharmacy programs delivers many benefits to health plans of all sizes. Here are a few of the benefits of outsourcing versus operating an in-house MTM pharmacy team:
Reduced recruitment and training costs
With the help of outsourcing, you don’t need to spend time or resources attracting, recruiting, or training clinical pharmacists. On average, it costs around $4,200 to hire a single employee. Imagine the cost to hire, train, and retain an entire team of MTM pharmacists to stand up a year-round program – a program in which your volume may ebb and flow throughout the year.
Not to mention the costs to build an entire technology stack in-house, from the ground up. Perhaps industry giants can afford to do so, but smaller, regional health plans simply can’t expend the dollars needed to stand up an MTM program from scratch. Finding a vendor partner who is experienced, has the full breadth of resources needed, and staffed by a team of dedicated professionals is the single best way to initiate an MTM program.
Focus on core competency
Since so many pharmacists change professions each year, it will be harder to retain top talent without providing them with the right tools and resources needed to focus on their highly visible roles with your members. MTM program needs often ebb and flow throughout the calendar year, and unless you have enough volume to keep your pharmacists engaged, you will likely struggle to retain them. Outsourcing allows you to focus on the current core competencies of your team, skip the process of developing or implementing complicated technology, and entrust your quality measure improvement and Star Ratings boost to a team squarely focused on delivering best-in-class results.
On the other hand, many health plans already have a full team of in-house pharmacists they employ. Reasonably, they aren’t inclined to do away with such teams of dedicated employees. That’s why the right vendor will have the flexibility for health plans’ in-house pharmacists to use the MTM platform as well. For example, through the Alliance by Aspen RxHealth platform, health plan pharmacists can use Aspen RxHealth’s proprietary technology to complete CMRs. Better yet, is that the entire Aspen RxHealth Pharmacist Community, thousands strong, is only the click of a button away, should there be unmanageable consult volume. Alliance by Aspen RxHealth provides the backup plan and reassurance that health plans need to feel confident in their MTM partner.
Identify at-risk health plan members
Having staff members analyze each individual plan member record is a timely endeavor, not to mention costly. Outsourcing the MTM program will ensure that at-risk health plan members get treated first, increasing satisfaction in the process. Leading clinical pharmacy partners, such as Aspen RxHealth, have the data, technology, and infrastructure in place to create curated matches between pharmacists and patients. It’s this matching technology that lays the groundwork for strong relationships between health plan members and their pharmacists, ultimately leading to long-term improvements to health outcomes.
Aspen RxHealth’s clinical engine ingests health plan member data, determines MTM eligibility, and then matches members with the most appropriate pharmacist to address their health and medication concerns during an MTM consultation. This makes the MTM process even simpler for health plans—simply provide the member data then sit back, relax, and watch in relief as your members get the high-quality MTM consultations to improve their health and bolster your Star Ratings.
How Aspen RxHealth's MTM solutions drive meaningful and measurable results
If the members don’t trust their health plan completely, the likelihood of medication nonadherence rises dramatically. In the end, a well-executed MTM program yields lower costs, better outcomes, and greater reimbursements.
Ultimately, if members aren’t engaged in their own health, MTM consultations won’t serve their intended purpose of identifying and correcting medication issues. That’s exactly why Aspen RxHealth has a relentless focus on training our pharmacists to be at their best for every patient consultation. Whether professional development programs, recurring daily huddles, a professional coaching team, or the countless informational resources available to them, Aspen RxHealth pharmacists have a world of training at their fingertips. Most valuable of all, Aspen RxHealth pharmacists receive extensive training in motivational interviewing—giving them the skills to empathetically meet your members where they are and speak to them in a way they can understand. That means they’re the best-equipped pharmacists in the nation to assist your health plan and most importantly, your members.
Through a cutting-edge platform, Aspen RxHealth pharmacists efficiently deliver high-quality medication therapy management care to members in need, no matter the language, condition, location, or demographic. Simply put, there’s no patient we can’t serve.
But if your health plan already has a high-performing team of pharmacists, we can still help. From supporting the back end of your in-house MTM operations to licensing our award-winning technology via our Alliance by Aspen RxHealth model, you’ll quickly become your team’s favorite boss. They’ll work through a user-friendly, easy to navigate application, delivering MTM consultations to members more easily than they may have thought possible.
If you’re a health plan focusing on harnessing the power of pharmacists to improve patient health, know that developing a best-in-class MTM program is merely the beginning. Companies like Aspen RxHealth offer a full suite of clinical pharmacy solutions to optimize medication use, prevent hospital readmissions, increase health literacy, and manage complex conditions. Learn how pharmacists can help in ways you may not have known.
When you’re ready to take the first step toward bringing your MTM program to new heights, the Aspen RxHealth team is ready and willing to assist. Drop us a line here or connect with us on LinkedIn.