SAN FRANCISCO – The biggest challenge for Medicare Part D Medication Therapy Management programs, or MTMPs, is to get active participation from patients. This task is even more daunting given that prior to Part D, there was no existing full Medicare prescription plan and only limited prescription drug coverage.
Under the 2003 Medicare reform law, the Centers for Medicare and Medicaid Services, or CMS, require all Part D plan sponsors to establish MTMPs for a particular set of beneficiaries so that prescribed drugs are appropriately used for best therapeutic outcomes.
To get their MTMP up and running successfully, Blue Shield of California is implementing clinical decision support technology from MedInitiatives to automate workflow and help the plan’s clinical pharmacists identify high-risk members, track them in the MTMP and measure outcomes.
MedInitiatives’ patient contact management and documentation system will extract patient data from consultations, track and coordinate their care. The system includes best practice guidelines and provides real-time information during consultations.
“These tools will help facilitate consultations for pharmacists and provide documentation so they can see claims history in one system,” said Dawn Becker-Ellison, medication management coordinator for Blue Shield of California.
“The main benefit of our technology is to minimize manual processes to better automate outcome evaluations of activities,” said Matt Simas, president and CEO of MedInitiatives. Many plans, such as Blue Shield of California, have already gotten all their data in one place. But the second step is to implement data analytics and clinical processes.
“Today, there is a high demand for business-user driven analysis,” he said. “There is a huge focus on data analytics and being able to have user-friendly tools.... CMS is very focused on quality improvement and outcomes.”
While it is too early in the program for Blue Shield of California to determine metrics and goals, Becker-Ellison noted that historically MTMPs have shown a decrease in the number of emergency visits and unscheduled physician visits and an increase in medication compliance.
