Welcome to Enhanced Medication Therapy Management: The First Step is Collaboration

Greetings, EMTM Pharmacist Participants,

When I was a young community pharmacist entrepreneur, I thought my professional life was akin to a sprint. As I matured, I found that my professional life was more of a marathon – a bit more patience was needed to hone the pharmaceutical care processes. Maybe you can relate?

As we initiate our exploration with you of a new way to apply Pharmacokinetic/Pharmacodynamic (PK/PD) science to practice, the watchword for our journey is ongoing collaboration. While Tabula Rasa HealthCare (TRHC) has been applying this science in practice for years, it has been in “closed” systems, meaning not in community pharmacy practice. In closed systems the results have been amazing (e.g., 20-60% reduction in hospitalizations).

The goal of this Centers for Medicare & Medicaid Services (CMS) pilot is for you to have ongoing consultation with your patients regarding application of the PK/PD science in order to significantly reduce their ER visits, hospitalizations, etc. To succeed in our Enhanced MTM (EMTM) endeavor with CMS, we must show that our interventions affect these outcomes. The metric CMS set for EMTM to achieve is at least a 2% reduction in Medicare Part A (i.e., hospitalizations) and Part B (i.e., physician office visits) expenditures. Since medication misadventuring is responsible for a large amount of these preventable expenditures, we each must work diligently with our patients to demonstrate that this new EMTM initiative focused on adding science at point of care is a solution. We have found a strong association between the Medication Risk Score (MRS) and medical spend – the higher the risk score (esp. above 10-15), the more the medical spend. The key for pharmacy in the forthcoming value-based payment model is to understand that process – filling prescriptions – is necessary but not sufficient in a model where ‘first comes outcome, then comes income’ is the requirement.

The government is paying pharmacy substantially more for EMTM cognitive services than it has been for MTM, with the hope that we will bend the medical spend curve via optimizing and individualizing pharmacotherapy. Thus, we are very keen on working through the issues that you uncover in community pharmacy practice using the MedWise Advisor® software and the application of such. Together, we are creating the foundation for a new, personalized – and even precision – process to optimize medication regimens for your patients, and to yield non-dispensing revenue for the profession.  Your position as a practice vanguard is not a ‘slam dunk’ event. It requires a systematic process, which entails collaboration.

We have found that the application of the Medication Risk Mitigation Matrix™ within MedWise Advisor will help you to identify and mitigate potential Adverse Drug Events. Equally important, letting patients know their MRS, and how science can be used to help them reduce it, will hopefully create a type of ‘Velcro’ between you and the patient. Most folks are familiar with their Fair, Isaac Company, or FICO, credit risk score; however, it is our goal for you to share with your patients their dynamic MRS, which is affected by Rx meds, OTC meds, samples, recreational meds, etc. Before they add any pharmacotherapy to their regimen, they need to check-in with their risk score and thus, you.

As we continue this CMS pilot program, we will be deploying other aspects to tether the patient to you and your pharmacy. First, we will introduce the MyMedWise Advisor (MMWA) app, which you can offer to your patients or their caregivers. This MMWA mobile app links you and your patient, or their caregiver, via iPhone or Android. If they want to take an OTC medication they have at home, they can add it to the MMWA app, and it will indicate how that addition will affect their MRS. In time, there will be a function whereby the patient/caregiver can contact you (or whomever you direct) via secure instant messaging, in real time. We are also trying to get CMS to reimburse us/you for pharmacogenomic testing – the results of such will load automatically into your MedWise Advisor platform. Stay tuned on that topic!

So, one step at a time. To help make the software user friendly for community pharmacists, we will keep a record of each suggestion that you share with us and we will let you know how our developers are progressing on fulfilling your suggestions.

Some of you will want to take this model outside your assigned EMTM patients – I know, many of you are entrepreneurs. You may want to start to market a “concierge pharmacist” type practice. Once we demonstrate outcomes, there will be additional opportunities for expansion into other areas of your practice. Initially, let’s focus our efforts on your assigned patients.

Lastly, just like the air force/ground force model, we will have in-place for you a messaging system whereby you can reach out to our many Board-certified PharmDs in one of our call-centers, whenever you need to have a question answered or are not sure of the best intervention to invoke. These pharmacists have been using the MRM Matrix system for quite a few years, and are delighted to help you as we start this new professional journey.

The fees associated with the use of the software are being covered through the EMTM Model pilot by CMS through 2021. However, as an early adopter of the software, after the CMS pilot ends, we will extend the use the platform at an affordable monthly fee per user station in your practice if you choose to continue its use.

As I am now in my fourth decade of pharmacy practice, I realize that our professional life is neither a sprint nor a marathon. It is a relay. A relay where someone (or, most likely, plural) hands you the baton. You run with it, only to hand it off to others. Thus, the essence of a successful relay is collaboration. Our relay, our collaboration, is for the sake of the profession entering into a new, science-based, relationship with our patients. Let’s enjoy this practice transformation together!

My very best, as you embark on a Tabula Rasa (i.e., new beginning) for you and your patients!

Sincerely,

Tabula Rasa HealthCare
Calvin H. Knowlton, BScPharm, MDiv, PhD CEO & Chairman
cknowlton@trhc.com