White Papers and Issue Briefs

• Annie Ideker, MD, Senior Medical Advisor—Clinician Experience, Senior Medical Advisor—Clinician/Patient, Relationships (Ambulatory), HealthPartners
• Mary Roth McClurg, Pharm.D., MHS, Professor and Executive Vice Dean-Chief, Academic Officer, UNC Eshelman School of Pharmacy

The article, written by GTMRx workgroup members from the Evidence-Based Resources Subgroup of the Practice and Care Delivery Transformation Workgroup, was published in the Journal of the American College of Clinical Pharmacy. It discusses existing gap areas and recommendations based off a review of current CMM-literature on implementation and impact. Authors include Heather L. Ourth, Pharm.D., BCPS, BCGP; Shawn McFarland Pharm.D., FCCP, BCACP; and Ashley P. Yost Pharm.D., BCPS, BCCCP—all from the VA.

NOTE: Access to the full version of this article requires a JACCP login or payment.

• Kathy Pham, Pharm.D., BCPPS, Director, Policy and Professional Affairs, American College of Clinical Pharmacy (ACCP)
• Ann Greiner, President, Chief Executive Office, Primary Care Collaborative (PCC)

One of the primary interventions in the treatment and prevention of disease is the use of medications. However, the unintended consequences from the use of medication regimens that are not optimized for the patient have been estimated to cost the United States $528 billion (based on 2016 data) and have resulted in more than 275,000 deaths annually.¹ How can we optimize the benefits to the patient and the use of medications, while minimizing the adverse consequences that are inherent in their use?

Abstract

Medicine is how we treat most conditions: Roughly 75%-80% of physician office and hospital outpatient clinic visits involve medication therapy.^1,2 And more often than we would like, it is how disasters occur. More than 275,000 die each year because of medication misuse, overuse or underuse. The financial cost tops $528 billion annually,³ and employers are on the hook for a large portion of that. Employers have the incentive, the leverage and the responsibility to change this. The evidence, best practices and tools are there to solve the systemic issues that lead to suboptimal medication use. Employers can lead the charge, through their contract authority and work with their suppliers, but they first must understand just how irresponsible doing nothing is.

Featuring the voices of

• Sandra G. Morris, RN, MSN, CHC, Senior Advisor, GTMRx Institute; President, About Quality Benefits Design; Former Senior Manager, US Benefits Design, Procter & Gamble and
• Jan D. Hirsch, BS Pharm, PhD, Founding Dean and Professor of Clinical Pharmacy School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine

1. McInnis, T. et al., editors. The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. 2nd ed., Patient- Centered Primary Care Collaborative.
2. Centers for Disease Control and Prevention. “Therapeutic drug use.” https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm
3. 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

Abstract

Employers want to build a better health care system, decreasing waste and ensuring access to an effective, efficient, low cost and high value delivery system that ensures access to services that are of highest quality, are safe and are appropriate. They have the power to make it happen.

This issue brief highlights:

• strategies to battle waste while improving care,
• employers who are focusing on medication,
• moving beyond medication therapy management to comprehensive medication management,
• which patients benefit the most from CMM; and
• rethinking drug benefit design.

Featuring the voice of Cheryl Larson, President and CEO, Midwest Business Group on Health and Employer Toolkit Taskforce, GTMRx Institute

• Molly Ekstrand, BPharm, BCACP, AE-C, Consultant with North Star Medication Optimization, LLC, GTMRx Institute
• Jane Gilbert, CPA, Director of Retiree Health Care, Teachers Retirement System of the State of Kentucky

• Paul Grundy, MD, MPH, FACOEM, FACPM, Chief Transformation Officer, lnnovaccer; President, GTMRx Institute
• Kylee Funk, PharmD, Associate Professor, University of Minnesota College of Pharmacy
• Todd Sorensen, PharmD, Professor and Associate Dean; Executive Director, College of Pharmacy, University of Minnesota; Alliance for Integrated Medication Management

1. “Clinical Decision Support as ‘A Bright Future for Healthcare Delivery:’ Episode 66, May 2019.

What will it take to expand the use of comprehensive medication management? Greater awareness among payers, providers and patients is required, of course. More specifically, it will require education and training. Perhaps the most important aspect is integration of CMM—and the clinical pharmacist—into the care team. That takes savvy in team-based care integration, creating collaborative practice agreements and more. This issue brief explores the need for CMM and implications for pharmacy education and training, as well as how CMM is integrated into team-based care models.

Featuring the voices of Terry McInnis, MD, MPH, president and co-founder, Get the Medications Right Institute and Foundation; president, founder, Blue Thorn Inc.; and Jan Hirsch, BS Pharm, Ph.D.,  director and founding dean,  Pharmaceutical Sciences University of California, Irvine.

Avoidable illness and death resulting from non-optimized medication therapy cost $528.4 billion in 2016, according to a peer-reviewed paper in the Annals of Pharmacotherapy. That represents 16% of the annual $3.2 trillion the U.S. spends on health care. This issue brief from Health2 Resources explores the research behind the figures and discusses the promise of comprehensive medication management as a systematic approach that can assure medications are appropriately and effectively used–making them both cost effective and assuring that all conditions are effectively managed with fewer side effects.

Featuring the voices of Terry McInnis, MD, MPH, president and co-founder, Get the Medications Right Institute and Foundation; president, founder, Blue Thorn Inc.; and Jonathan H. Watanabe, Pharm.D., M.S., Ph.D. BCGP, associate professor of clinical pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego.

Defining an intervention and ensuring consistency in delivery is necessary to establish a common understanding and set of expectations across key stakeholder groups including patients, pharmacists, physicians, other health care providers, and payers. This also allows the service to be recognized as distinct, yet complementary to care provided by the primary or specialty care provider. An intervention, such as comprehensive medication management (CMM), focused on optimizing medication use must be defined with a degree of specificity that allows consistent training of clinical pharmacists and other health care providers, replication of the service, and observable fidelity of the service across practitioners.

This white paper provides a framework and common language for understanding CMM and delivering it through a detailed patient care process. It was funded by the American College of Clinical Pharmacy, the American College of Clinical Pharmacy Research Institute and the UNC Eshelman Institute for Innovation. Content was developed by researchers at the UNC Eschelman School of Pharmacy, University of Minnesota College of Pharmacy and the University of Colorado.

• Goodrich Pharmacy has 18 pharmacists at seven sites; five sites provide CMM. In 2015, they saw roughly 900 CMM patients and 700 disease-state medication management patients. Goodrich also contracts with six primary care clinics, providing CMM patient consultations for a flat fee. Steve Simenson, BPharm, FAPhA, DPNAP, is president and managing partner.

It’s long past the time to talk about “pilots” or “emerging practices” when discussing comprehensive medication management (CMM). CMM programs have been tested and retested, the results studied and documented. It’s not emerging: It has emerged—as a practice to improve outcomes, control costs and enhance the satisfaction of clinicians and patients alike. Health systems, patients, physicians—even payers—are beginning to understand the value of advanced clinical pharmacy services and the importance of integrating those services collaboratively into community/ambulatory team-based care, explains Terry McInnis, MD, MPH, CPE, FACOEM, in this white paper.