By Katherine H. Capps, Co-Founder and Executive Director, GTMRx Institute; President, Health2 Resources
February 15, 2021
New conversations, new audiences: It’s time to spread the word
We need to talk. Not just to each other, but to our communities.
Many of us have been advocating for medication optimization for years. We’re largely on the same page. But are we adequately reaching a broader audience? I’m not sure.
That’s why we must continue to call on policymakers, business leaders and clinicians to optimize medication use through comprehensive medication management (CMM), replacing trial-and-error prescribing with a personalized, team-based, coordinated and systematic process of care. Only then can we improve patient outcomes and reduce the total cost of care.
We must engage in these conversations with colleagues, with professional organizations, business leaders, policymakers, lawmakers and clinicians.
Show them the evidence
We know CMM works. Research shows that optimizing medications through CMM can decrease misuse, overuse and underuse of medications. We’ve even compiled the evidence in a document anyone can access–and share.1
CMM has a long record of success. A 2012 paper looked at team-based medication management services and placed the ROI around 3:1 to 5:1–and as high as 12:1. That translated into a reduction of between $1,200 and $1,872 per patient per year for the first five years.2
We know this. Now, it’s time to spread the word.
Specific examples are always helpful. Take Fairview Health. It has collected data that shows its comprehensive medication program improves clinical quality, reduces total cost of care and enhances the experience of patients and providers. Among patients with diabetes, Fairview saw a 33% reduction in readmissions to the hospitals and lower costs.3,4,5,6
That’s just one of the many stories illustrating the evidence behind CMM. And we must be clear that that evidence supports comprehensive medical management, not medication therapy management (MTM) in general.
How comprehensive is your medication therapy program?
Begin this conversation by defining terms and distinguishing medication therapy management from comprehensive medication management. Here’s one analogy I like: You wouldn’t refer to all cars as Lamborghinis. CMM keeps being conflated with medication therapy management (MTM).
We often hear the terms used interchangeably. That’s inaccurate. MTM encompasses all types of medication management. It’s hard to say what it is, but it isn’t comprehensive.
Today, many MTM programs blame the “non-compliant” patient for lack of results. That’s misguided. Lack of adherence accounts for less than 15% of medication therapy problems.7 If only it were that easy!
In MTM, it’s often unclear exactly what the intervention is and what steps are being taken to care for the patient so it is hard to measure results. CMM, in contrast, requires follow-up to confirm that changes were made and that they produced the intended outcome–medication optimization.
Here’s the bottom line: MTM is medication-focused. CMM is patient-centered.
CMM offers a systematic, whole-person approach to medication management. It’s personalized.
How do we move from precise to personal?
That’s an easy question to answer, although the concept may be a little difficult to communicate to those outside of health care. But let’s give it a shot.
Pharmacogenomics (PGX) is an important tool to help us advance both precise and personalized medicine. It gives providers insight into how an individual patient’s genes may affect their response to certain medications. The need for such a tool becomes clear when we recognize that roughly 90% of the population has at least one genetic variant that may affect the way they respond to medications, increasing the likelihood of side effects and/or treatment failure.8,9
So far, so good. But we’ve focused on precision. Where’s where personalization comes in: PGx as part of CMM moves us to care that is precise and personalized. PGx testing makes the treatment more precise. Using it as part of the CMM process makes care personalized. We have the evidence to show the value here as well.
Now is the time
We can equip you for these conversations. The GTMRx Institute has tools and resources you can use as you engage in these conversations. We even have a roadmap: The GTMRx Blueprint for Change includes recommendations to engage everyone involved in patient care, including physicians, clinical pharmacists, health plan sponsors, consumer groups, legislators and policymakers.
It’s time: Nearly 75% of primary care visits involve a prescription.10 Medicine is how we treat most conditions. But we fail to get the medications right. More than 275,000 lives and $528 billion are lost each year due to non-optimized medication use. 11 We have the evidence, best practices and tools we need to solve the systemic issues that are causing suboptimal medication use. We must get the medications right.
Start talking.
[1] 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
[2]Cipolle RJ, Strand L, and Morley P. Pharmaceutical Care Practice: The Patient Centered Approach to Medication Management. Third Edition. New York, NY: McGraw-Hill Medical; 2012.
[3] Brummel A, Soliman A, Carlson A, Ramalho de Oliveira D. “Optimal Diabetes Care Outcomes Following Face-to-Face Medication Therapy Management (MTM) Services.” Population Health Management. October 31, 2012.
[4] Brummel, A, Carlson, A. “Comprehensive Medication Management and Medication Adherence for Chronic Conditions.” Journal of Managed Care Pharmacy 2016; 22 (1); 56-62.
[5] Budlong, H, Brummel, A, Rhodes, A, Nici, H. “Impact of Comprehensive Medication Management on Hospital Readmission Rates.” Population Health Management 2018.
[6] Get the Medications Right: Innovations in Team-Based Care June 2020
[7] Comprehensive Medication Management in Team-Based Care. American College of Clinical Pharmacy. www.accp.com/docs/positions/misc/CMM%20Brief.pdf.
[8] Ji, Yuan, et al. “Preemptive pharmacogenomic testing for precision medicine: a comprehensive analysis of five actionable pharmacogenomic genes using next-generation DNA sequencing and a customized CYP2D6 genotyping cascade.” The Journal of Molecular Diagnostics. 2016;18(3):438-445
[9] Van Driest, Sara L., et al. Clinically actionable genotypes among 10,000 patients with preemptive pharmacogenomic testing. Clinical Pharmacology & Therapeutics. 2014; 95(4):423-431.
[10] Slone Epidemiology Center at Boston University. Patterns of medication use in the United States 2006: a report from the Slone Survey
[11] Watanabe JH, McInnis T, Hirsch JD. Cost of prescription drug-related morbidity and mortality. Ann Pharmacother 2018;52(9):829-37. https://doi.org/10.1177/1060028018765159
