Practice Transformation
Team-based care begins with the patient
In a Pharmacy Times interview, Michael S. Barr, MD, MBA, MACP, FRCP, Executive Physician Advisor, GTMRx Institute, discussed the importance of collaboration among physicians, other clinicians and pharmacists in delivering comprehensive medication management. “It starts with the person needing the care…[and] includes understanding that well organized team-based care is the best way to approach patient needs, especially those who have challenging situations or complex clinical conditions.” Such an approach begins with each member acknowledging their respective responsibilities and knowledge and collaboratively supporting the patient’s. He also shared real-world examples about how team-based CMM improves outcomes while reducing costs. (Pharmacy Times)
Evidence & Innovation
Tackling cancer, battling the insurance system
Actress and author Annabelle Gurwitch has stage 4 lung cancer. But the real battle is with insurers and PBMs. “With my one-pill-a-day biomarker-directed therapy, I prefer to say that I’m ‘tackling’ cancer. But if I am at war, it’s with an insurance system that works more like an extortion scheme.” She relates how she spent “many hours of my cancer-shortened life span” trying to get her PBM to rectify a $4,445 error. “[T]o a PBM, I’m a liability, so until science finds a cure, I can expect many more soul-sucking hours of haggling over insurance benefits.” (Washington Post)
Docs embrace digital tools to improve outcomes and efficiency
Doctors continue to warm to digital health tools, according to an AMA survey. For example, 93% said digital health tools can improve patient care in 2022, up from 85% in 2016. The increases were seen across all specialties and ages. The average number of digital health tools in use by a physician grew from 2.2 in 2016 to 3.8 in 2022. Improved clinical outcomes and work efficiency are the top factors influencing physician interest in digital health tools. The ability to help reduce stress and burnout wasn’t far behind. (Chief Healthcare Executive; AMA)
Kroger, others, drop Express Scripts
Grocery store chain Kroger, which has more than 2,000 pharmacies across the nation, has terminated its contract with Express Scripts because the pharmacy services provider’s “drug pricing model is unsustainable.” Meanwhile, according to the Military Officers Association of America, nearly 15,000 community pharmacies are leaving the Tricare network, affecting about 4% of the Tricare-eligible population. Express Scripts manages pharmacy benefits for Tricare.(Becker’s Hospital Review; KSWO)
Policy Solutions
OIG: $18B wasted on drugs with no proof of value
The Medicare and Medicaid programs spent more than $18 billion over three years on medications for which there was no proof of a significant clinical benefit, according to an HHS Office of the Inspector General report. The report is part of the OIG’s ongoing evaluation of medicines cleared through the FDA’s accelerated approval process. At the same time, Congress is expected to reauthorize the Prescription Drug User Fee Act without giving FDA the authority to ensure completion of trials for drugs cleared via the accelerated approval process. (Medscape; OIG report)
Help CMS create centralized provider directory
CMS has released a request for information (RFI) seeking public input on a National Directory of Healthcare Providers and Services. Such a directory would help patients navigate the health care system and facilitate care coordination. CMS is seeking comment on how a CMS-led directory could reduce directory maintenance burden on providers and payers by creating a single, centralized system, promoting real-time accuracy for patients. Using modern interoperable technology would allow payers to update their own directories seamlessly from a single directory . (CMS RFI; RevCycle Intelligence)
In Case You Missed It!
GTMRx Workgroup Update
On October 7, 2022, Todd D. Sorensen, PharmD, FAPhA, FCCP, Executive Director, Alliance for Integrated Medication Management (AIMM) spoke to GTMRx’s workgroup leadership on AIMM’s Regional Integrated Transformation Zone (RITZ)—a community of service providers who are committed to better health outcomes and a higher quality of life for populations who are not achieving their desired clinical goals.? Sorensen’s colleague, Mark Hawkins, MBA, Consultant, AIMM?, also presented, describing the Empire Foundation’s work as a specific example of a RITZ in action and how it brings CMM and care coordination to a population in need. ?
GTMRx in Health Affairs | Underappreciated CMM is the missing ingredient to value-based models
Comprehensive medication management is the missing ingredient in value-based models, but despite evidence supporting its effectiveness and value, it remains underappreciated and underused, a group of GTMRx leaders write in Health Affairs Forefront. They highlight the evidence for CMM, including how it supports all five elements of the Quintuple Aim—including the newest aim, equity. Their a call to action: Align on the standardized definition of CMM “to promote well-defined CMM practice standards for consistent implementation, and to promote properly resourced CMM services in value-based contracting.” (Health Affairs Forefront)
GTMRx Blog | Credible, current and accessible: Finding the drug data to get the medications right
To get the medications right, care teams need access to the most current, evidence-based information about those medications—ideally, at the point of care.
We all understand this. Making it happen, however, has been a longstanding challenge. Often, the relevant information isn’t always accessible.
That’s not to say that information is not available. The package insert is readily available, as are published research. Both may be dated and incomplete….
GTMRx Blog | Leveraging trust for behavior change: Interdisciplinary team connects with hard-to-reach patients, addresses medication and SDOH problems
Patient trust can be difficult to cultivate, but it’s essential to ensure patients receive the right medicine in the right amount at the right time. That applies to any patient, but it’s especially true for individuals without a relationship with a provider.
Community-based care coordination is a powerful tool. That’s why the centerpiece of Medication Care Coordination (MCC), a care coordination initiative in rural Washington State, is a community-based care coordinator who visits individuals in their homes, building trust and serving as their advocate. This care coordinator connects the patient remotely with pharmacist and the primary care provider. Because the patient trusts the care coordinator, they are more likely to trust the pharmacist and provider—think of it as a halo effect.
New Report Available! Optimizing Medication Use for Accountable Care Success
A value-based care resource derived from an event sponsored by the GTMRx Institute & the Institute for Advancing Health Value
This report covers:
- Comprehensive medication management (CMM) in ACOs/ enhancing value
- The reported effects of CMM and pharmacy integration
- The key elements of success for effective medication therapy management programs
- Key issues impacting CMM success in ACOs, such as:
- Population health
- Social determinants of health
- Using data to transform care
- Change management/philosophy of practice
- Network expansion and clinical integration
- Accountability and relationship management
Read the report here.
Join us to be part of meaningful change
Irma, like many others, struggles as a result of our current trial-and-error approach to medication. That is why we advocate for a new, comprehensive approach to medication use and prescribing. As a non-profit 501(c)(3) and 501(c)(4) organization, the GTMRx Institute and Foundation relies on funding from our supporting members. We ask that you consider becoming a Supporting Signing Member so we can continue to provide relevant, timely resources to get the medications right!
If you’re interested in supporting the Institute or Foundation at a higher level, please contact us. Your dollars will bring about meaningful change for people like Irma.
AmazonSmile is an easy way for 0.5% of your qualified purchases go to the GTMRx Foundation at no cost to you. And signing up is simple—go to smile.amazon.com and select “Get the Medications Right Foundation” as your charity of choice. If you prefer to directly donate instead, you can do so here.
Adding the foundation on AmazonSmile will help us continue to provide no cost educational webinars, issue briefs, weekly news briefs and promote the need for transformation of our current system of medication use through social media campaigns.
