Eighty percent of the way we treat and prevent illness is through medications. With that in mind, it is extremely important to get the medications right.
There are too many lives lost and many dollars wasted because of non-optimized medication therapy. Avoidable illness and death resulting from non-optimized medication therapy cost $528.4 billion in 2016, according to a peer-reviewed research paper in the Annals of Pharmacotherapy. That represents 16 percent of the annual $3.2 trillion the U.S. spends on health care.
In 2018, UC Irvine School of Pharmacy & Pharmaceutical Sciences Founding Dean Jan Hirsch and Associate Dean of Assessment and Quality Jonathan H. Watanabe led a study on the “Cost of Prescription Drug-Related Morbidity and Mortality.” In conclusion, the authors proposed the expansion of comprehensive medication management (CMM) programs by clinical pharmacists in collaborative practices with physicians and other prescribers as an effective and scalable approach to mitigate these avoidable costs, improve patient outcomes, and raise population health.
As a leading expert in CMM, Hirsch served as a presenter for the Get the Medications Right Institute (GTMRx) webinar held in June 2021. The virtual event was designed to educate employers about CMM and demonstrate ways to implement a buy-right strategy when working with medical carriers, pharmacy benefit managers, etc. The webinar also illustrated how employers – as health plan sponsors – can structure benefit plan design on the medical and pharmacy side as they pursue value-based care.
During her presentation, Hirsch talked about how CMM is being used today to effectively transform and optimize medication use while achieving measurable, positive treatment outcomes that save lives and money. She also talked through the cases of several patients who have benefited from CMM.
In comparing medication therapy management (MTM) to CMM, Hirsch said: “MTM is somewhat siloed and it’s a one-off type of intervention. The pharmacist is looking at a wide array of drugs and they are looking for an intervention that can be made at that particular time. Some MTM is from patient records and some involves one-on-one time with the pharmacist and the patient.
“The thing that doesn’t happen in MTM is continued follow-up that exists with CMM. There also isn’t the collaborative practice with the physicians or other prescribers on an ongoing basis. In general, CMM is more collaborative and longer term.”
With pharmacists serving as the most accessible and frequently visited members of the healthcare team, their impact on CMM can be far reaching while preventing unnecessary care and saving patients out-of-pocket costs.
Significant evidence is accumulating to establish the positive impact that CMM has on patient outcomes. As presented by Hirsch, the patients who benefit most include those:
- With one or more chronic conditions treated by multiple providers
- With high emergency room (ER) / urgent care / hospital utilization
- With one or more complex medications requiring specialized administration and frequent outcomes assessments
- Transitioning between specialists and primary care providers visits, ER / urgent care visits, or discharge from a hospital / long-term care facility
- At risk for sub-optimal clinical outcomes due to medication therapy problems such as errors in self-administration, doses too high or low, adverse drug reactions, etc.
- Taking new medications requiring personal education and ongoing assessment of outcomes (inhalers, self-injectables, narrow therapeutics index, etc.)
- Showing absence of or erratic maintenance of intended therapy goals
- Problems understanding and following their medication regimen
The GTMRx Employer Toolkit, which explores the benefits of CMM for individuals and for the employers who pay for benefits, was distributed to the webinar attendees. Co-presenting with Hirsch was Sandra Morris, a senior advisor for GTMRx and former senior manager of U.S. benefits design for the Proctor & Gamble Company.