By Katherine H. Capps, president, Health2 Resources | June 2016
If you want to upset me, tell me “Oh, it’s just semantics.” Words, and the way we use them, matter. How we label things matters. If you need ibuprofen, you don’t say “I’d like an analgesic.” And if you want a Pepsi, you don’t ask for a cola–or worse, a “Coke.” Call a rose by any other name and you’ll just confuse the heck out of everyone.
In health care, we need more clarity and precision in our language. There’s a saying attributed to Confucius that goes something like this: “The beginning of wisdom is to call things by their proper names.” It’s something I’ve been thinking about a lot lately, prompted by my role as project director for a new report on comprehensive medication management.
That report, Get the medications right™: a nationwide snapshot of expert practices–Comprehensive medication management in ambulatory/community pharmacy, was released last month by my firm, Health2 Resources, and Blue Thorn Inc. It shows how pharmacists, as both medication experts and clinicians, are optimizing medication use in team-based care and making an impact on the communities–and patients–they serve. Sponsored by a grant from the Community Pharmacy Foundation, the report draws on responses from 618 practices across the country. It highlights the importance and the role of the clinical pharmacist in patient care. It also features a number of interviews with successful CMM practices. Those practices we interviewed forced me to think about semantics.
Although the pharmacists interviewed understood what CMM entails, some used more general terms, such as “medication therapy management.” Although correct–CMM is a form of medication therapy management (MTM) the way Coke is a cola—it does not differentiate CMM from other forms of MTM such as Part D Comprehensive Medication Reviews, disease-state medication management, or medication reconciliation.
In effect, it confuses payers, patients, and policymakers, and it doesn’t give the clinical pharmacist practices enough credit for the systematic and team-based integrated care CMM requires.
Defining our terms
Comprehensive medication management encompasses a number of activities and involves a whole-patient approach that begins with the needs of the individual, not the condition. CMM programs seek to optimize medications by identifying and resolving drug therapy problems that stand in the way of clinical goals. In The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes, it’s defined as
the standard of care that ensures each patient’s medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.
By any other name
Is it still comprehensive medication management if you call it something else? If certain program elements and processes are in place, the answer is “yes.” But when you call it by another name, it becomes difficult to discuss CMM’s unique value. That can lead to confusion. Patients, providers and payers already lack a basic understanding of CMM. Why further cloud the issue?
Yes, this is about semantics. Words matter.
We cannot educate patients, physicians, health plans and policymakers if we don’t use the right terms, set expectations about what they can and should expect, and then deliver on those expectations.
By providing clarity and offering real-world examples, we believe this report will start many important conversations about comprehensive medication management. As the title says, it will help us get the medications right™.
It is my fervent hope that we will have the wisdom to get the name right, too.