Katherine H. Capps
Co-Founder and Executive Director
December 15, 2021
A sparkling solution: CMM is the innovation we need. Stop stalling.
In a season of hope, I’m feeling a just little frustrated about the current health care system’s resistance to change. Specifically, of course, I’m talking about giving patients access to comprehensive medication management through team-based, person-centered care. The potential of CMM is undisputed, yet we still lack buy-in from the very stakeholders who could bring it to scale.
It’s as though someone gave me a case of vintage Veuve Clicquot, and all I had was one old plastic tumbler. Yes, the champagne would still be amazing, but it would never live up to its potential.
Two questions from a recent survey of health care leaders that we conducted illustrate the promise and predicament of CMM.
First, to evaluate perceived value, we asked this question:
Do you believe access to team-based, person-centered comprehensive medication management (CMM) services will ensure a safer, more effective and appropriate way to manage medications and avoid medication misadventures?
Ninety-eight percent (78% strongly and 20% somewhat) of the 209 respondents agreed. That’s encouraging, even if it’s not surprising. This gives one hope, right?
But then, there’s this question:
How confident are you that our health care system will move toward a person-centered, comprehensive and integrated care system to manage, monitor and adjust a person’s medications across the care continuum within the next three years?
And as long as we are siloed, we can’t talk to each other.
Communication remains the issue
Only 21% predict that communication will improve due to access to new technologies and data-sharing rules.
Why do we have this communication problem? There are several reasons; here are three that I think are paramount:
- Lack of integration: To exert control over cost drivers, employers (as health plan sponsors) and the government have historically carved out behavioral health and pharmacy benefit management. I would argue that it is time to smartly integrate them back into patient care models to provide whole-person care and create accountable teams. While employers should still focus like a laser on high-cost areas, these carve out strategies create fragmentation and coordination of care suffers. They disaggregate the delivery of care at the expense of high-quality patient care.
- Lack of interoperability: Ideally, all members of the patient care team should have full access to all relevant clinical information at the point of care. We’re not there yet. A physician may not have access to a patient’s complete medication lists, and a clinical pharmacist may lack a complete picture of a patient’s health status, diagnostic findings or physician stated goals of clinical therapy.
- An unwillingness to pay for team-based care and value over volume: Professional silos prevent good patient care. Fix this, expand access to clinical information at the point of care for all team members, and move to new value-based payment models that reward the team based on outcomes, and I believe integration, quality and interoperability will dramatically improve.
How do we move forward?
We must be vigilant about getting the medications right. This applies to advanced primary care, oncology care and high-cost care provided by specialists. A focus on optimizing medication use across the continuum of care decreases their misuse, overuse and underuse and is a more rationale approach to getting the medications right..
We’ve collected and compiled peer reviewed evidence.1 We have agreement in principle about how to move forward. We have a blueprint: The GTMRx Blueprint for Change. We have the tools. We have the use cases. And as the recent survey confirmed, we have a solid solution. However, we all know solutions require change. And change requires action. And that, again, is the source of my frustration.
We won’t heal our broken system until everyone does their part.
- Payors must recognize the need to look beyond adherence programs. They must understand the value in expanding more comprehensive, person-centered medication management solutions. To solve drug therapy problems, it’s important to first address the issue of appropriate medication use. If a patient adheres to the wrong medication, it could be fatal.
- Policymakers, like payors, must move beyond support for fee-for-service reimbursement to full support for value-based payment models that will reward the interprofessional team. There is a real opportunity to advance and expand payment for team-based primary care and marry a more effective medication-use process.
- Employers, when considering the prescription drug benefit, must think about the big picture. How are medications selected, managed and monitored? How effectively are drug problems being identified and addressed? Many are hungry for a solution that allows them to think about the big picture. In an earlier survey, we learned that 87% of HR leaders believe their company would benefit from a more innovative way to manage medication therapy problems. Nearly all (92%) agreed that offering a medication expert and/or clinical pharmacist would be helpful in better understanding medications.
The most powerful people, however, are those actually working in a medical practice: physicians, nurses, pharmacists and other providers.
At the practice level
Our survey found that 40% of the respondents believe the physicians, pharmacists and nurses at the care team level have the most impact on making a lasting change for removing professional silos that prevent person-centered integrated care. Adopting a team-based approach, in which a medication expert works in collaborative practice with the physician, will significantly reduce the total cost of care, improve quality and enhance physician satisfaction while helping patients achieve clinical goals of therapy.
Patients deserve a coordinated, interprofessional team empowered with information at the point-of-care available to deal with medication therapy problems.
Immediate is not fast enough
So, here’s my question to you: How long can we wait for our health system to move toward a person-centered, comprehensive and integrated process of care that will manage, monitor, change, stop or adjust a person’s medications across the care continuum?
We can’t wait.
Despite the barriers, despite my frustration, I do believe we can make it happen. It’s time to uncork the champagne.
- The Outcomes of Implementing and Integrating Comprehensive Medication Management in Team-Based Care: A Review of the Evidence on Quality, Access and Costs, GTMRx, October 2020