Medication Therapy Management is Essential to the Success of Emerging Healthcare Models

Medication Therapy Management is Essential to the Success of Emerging Healthcare Models

As I pointed out in my previous blog, one of the biggest buzzes at HiMSS11 was the growing prevalence of proactive, value- and outcomes-based care delivery models such as accountable care organizations (ACO) and the patient-centered medical home (PCMH). We're all aware by now that this is an outgrowth of reform, which is largely targeting the excessive wasteful spending that plagues the U.S. healthcare system.

With that established, it's important to examine the factors that comprise wasteful spending in healthcare, and medication-related problems are one of the most significant. They account for some 1.5 million preventable adverse events each year that cost the health insurance industry an estimated $177 billion in additional healthcare programs.

Congress coined the term medication therapy management' in the 2003 Medicare Modernization Act. It is defined by the American Pharmacists Association as "a distinct service or group of services that optimizes therapeutic outcomes for individual patients." As we move to more comprehensive and patient-centric care management models that replace fee-for-service with outcomes-based reimbursement that emphasizes care coordination as patients (especially those with multiple co-morbidities) move across the care continuum, MTM will be critical.

And this creates a unique opportunity for health plans. Since they accrue the most comprehensive data regarding a member's health services and medications, payers are best positioned to ensure optimized health outcomes through MTM tools and programs. Consequently, this will significantly increase the need for health information technology tools for population-based and individualized analytics, quality reporting and care management.

We cover the MTM issue and its various implications in the latest edition of our MEDecision Insight Series of e-books. I invite you to download "Medication Therapy Management A Case for Health Plan Intervention" at http://bit.ly/eIBMWG and share your thoughts with us on this topic, which I think will only grow in relevance and prominence in the coming weeks and months.

Also, we're conducting a complimentary webinar on MTM on Wednesday, March 16; register at http://bit.ly/eROOzy. I hope you can join us

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