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NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation Medication Therapy Management Organization Overview • McKesson is the oldest and largest healthcare company in the nation, serving more than 50% of U.S. hospitals, 20% of physicians, and 96% of the top 25 health plans • The company collaborates with healthcare organizations of all types to strengthen the health of their businesses by helping them control costs, develop efficiencies, and improve quality • The company delivers one-third of all medications used daily in North America Background In 2012, the Congressional Budget Office estimated that a 1% increase in the number of prescriptions filled by beneficiaries would cause Medicare’s spending on medical services to drop 0.2%. Between $100 and $300 billion of avoidable healthcare costs have been attributed to non-adherence in the US annually, representing 3% to 10% of total US healthcare costs. In response to the government’s focus on decreasing healthcare spend, healthcare plans and other key stakeholders are now incentivized to improve the quality metrics associated with their beneficiaries. The pharmacist can have a direct impact on patient health and associated costs by improving adherence and closing gaps in care. This has led to the development of Medication Therapy Management (MTM) services, through which patients are counseled about appropriate medication use, potential drug interactions, adherence strategies, and other topics. After many failed attempts to deliver MTM services centrally, a majority of plans have relied on community pharmacies to impact these metrics. The McKesson MTM program is designed to leverage the strength of the independent pharmacy-patient relationship to increase both the level and quality of patient engagement in MTM services. Program Details The goal of McKesson’s MTM program is to support pharmacies in their evolution to a patient-centric business model, focused on driving outcomes and expanding clinical services offerings to meet the broader industry needs. Areas of focus include adherence for diabetes, hyperlipidemia and hypertension, high risk medications, and diabetes gaps in care. In the fall of 2013, the program partnered with a major PBM and was piloted in 3 states in the Northwest. Based on its success, a nationwide program was launched in 2014. The roll-out included: • Mass enrollment of approximately 6,000 pharmacies in the MTM vendor program and participation from all major PBMs • A series of over 100 live “Town Hall” educational sessions for independent pharmacies each year, for the last three years, which are focused on the changing healthcare landscape, importance of clinical performance, and necessary actions for improvement An Initiative of the 23 | Medication Therapy Management
NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation • A roadmap providing pharmacies with educational and operational resources • Tools to enable MTM case completion and outcomes improvement, such as visual aids, coaching guides, and outbound clinical advisor calls In 2016, McKesson added patient-level alerts during claims adjudication, in partnership with RelayHealth and a leading MTM service provider. Case summary reports were also incorporated at this time to increase MTM completion rates and further expand patient reach. Value Delivered The McKesson MTM program has delivered value in three areas: Awareness: Through local town halls, 1:1 outreach, broad communications, training, and tools, McKesson has greatly increased the pharmacies’ understanding of the importance of the Federal MTM/STAR Ratings program to their patients, their pharmacy, and the healthcare system. Adoption: The McKesson team developed and employed tools and solutions to improve medication adherence and gaps in care. Examples include patient-level case opportunity alerts, outcomes dashboards, and medication synchronization resources. Performance: MTM efforts have yielded significant improvements in pharmacy performance. Patient acceptance rates (per one major MTM platform) are some of the highest in the industry. In addition, over 2,000 Health Mart pharmacies (McKesson’s independent pharmacy franchise) are performing in the top 20% in one or more key quality measures that contribute to plans’ CMS Star Ratings. Path Forward In the short term: • McKesson has recently concluded a customer study on the pathway to success for pharmacies that are focused on improving patient outcomes and store profitability • Health Mart will continue to deliver ~100 Town Halls this year, with a focus on moving pharmacists down performance pathway, and has added new pharmacists and experts in adherence and health behavior change • AccessHealth, McKesson’s pharmacy services administrative organization, will increase serve rates by expanding the work flow and case summary alerts to a broader group of pharmacies • McKesson Pharmacy Systems and Automation has also developed a new platform to help bring disparate MTM and other clinical opportunities together into one streamlined pharmacy workflow The long term goal is to drive the patient-centric care model across the entire pharmacy base. Key steps will include: • Improvement toward industry-leading STAR Ratings • Adoption of medication synchronization to drive efficiency • Inclusion of broad clinical services offerings (such as immunization, care coordination, discharge services, disease state management) In addition, McKesson believes that the success of the program can be enhanced through policy changes that will: • Standardize documentation across different vendors for MTM services • Prioritize face-to-face MTM service delivery by pharmacists or other qualified healthcare providers • Put forward reimbursement strategies for pharmacist-identified patient interventions Medication Therapy Management | 24
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