Practice Transformation
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)
Columnist: Primary care innovation could safe health care
Can innovation in primary care slay the health care leviathan? That’s the question Seth Joseph, managing director of Summit Health, asks in a two-part column for Forbes. His answer? “That may be too much to ask of one sector alone. But it’s an awfully good place to start trying.” He notes that researchers from Harvard found that companies innovating in primary care had raised $16 billion in 2021 alone. Primary care is having its moment, he says, making a case for increasing investment in primary care. (Forbes)
Evidence & Innovation
MA accounts for almost half of Medicare
Nearly half of eligible Medicare beneficiaries – 28.4 million out of 58.6 million – are enrolled in Medicare Advantage plans, according to the Kaiser Family Foundation. That represents a more than doubling of the share of the eligible Medicare population enrolled in such plans from 2007 to 2022. Among the other findings: In 2022, 69% of Medicare Advantage enrollees are in plans with prescription drug coverage that require no premium other than the Part B premium. Nearly all (99%) of MA enrollees are in plans that require prior authorization for some services, such as prescription drugs administered by a physician. (KFF)
Your employees only think they understand insurance
Open enrollment may require a bit more education that you think: Employees think they understand health insurance enrollment, but their responses to a Harris poll suggest otherwise. More than 80% of those surveyed said they were knowledgeable or very knowledgeable, but most lacked an understanding of the basic facts about health insurance. For example, 54% could correctly define “deductible,” and 63% either thought that they could make changes to their health plans or dependent coverage after enrollment or didn’t know. Employees between 18 and 44 were particularly ill-prepared for health insurance enrollment decisions. (HealthPayer Intelligence; survey results)
Policy Solutions
JAMA commentary looks at future of drug reform
The Inflation Reduction Act allows Medicare to directly negotiate prices for certain drugs, limit price increases and reduce out-of-pocket costs for Part D beneficiaries. A commentary published in JAMA notes that these represent “a step toward greater affordability of prescription drugs for Medicare beneficiaries.” Now, the focus turns to implementation. Current and future administrations will be able to use executive authority to address the legislation’s limitations. They can work with Congress to extend reforms to the uninsured and the privately insured. States and private purchasers will need to continue to develop their own strategies for addressing drug costs. (JAMA)
In Case You Missed It!
GTMRx Blog | “Health equity and CMM: You can’t have one without the other”
A key element of health equity is appropriate access to a high-quality health care team—a team whose members take the time to understand the needs, challenges and preferences of the individuals who entrust their care to them.
Clinical pharmacists, as members of the team, are the medication specialists. Through the process of comprehensive medication management (CMM), they get to know their patients’ individual needs related to medication. These aren’t just medical needs: They are social needs and risks as well as personal challenges and preferences. The clinical pharmacist then identifies opportunities to help optimize the benefits of all the medications—prescriptions as well as nonprescription (analgesics, alternative, vitamins and supplements, etc.)
To address social drivers of health and reduce health inequities, we must gather and use data to inform our actions. Clinical teams and their staff need to build trusting relationships with patients and families so they are willing to share their information…
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.
Recording now available! Integrating Pharmacists into Advanced Primary Care: A Better Way to Manage Medication
GTMRx’s Katherine Capps hosted Mini Summit 31: Integrating Pharmacists into Advanced Primary Care: A Better Way to Manage Medication with Julie Ceno-England, M.D. (OneOme), Mitchell Kaminski (Jefferson College), Michael Hochman (SCAN), and Steven Chen (USC School of Pharmacy).
This presentation was part of the National Primary Care Transformation Summit July 25-29, 2022. The event featured in-depth conversations and discussions with leaders from CMS/CMMI, VillageMD, Aetna/CVS, Humana, United/Optum, Boeing, Google, Walgreens and others involved in primary care transformation.
Watch 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.
