A blog post by Karen van Caulil, PhD, President & CEO, Florida Alliance for Healthcare Value
Employers are always looking for ways to drive value in health care for the plans they manage and for their employees. They especially want to do this for medications.
This isn’t news to anyone who works with employers, and a 2021 survey of more than 300 HR leaders confirmed it for everyone else. Fully 87% of respondents said they believe their company would benefit from a more innovative way to manage medication therapy problems. Nearly all (92%) agreed that offering a medication expert and/or clinical pharmacist would be helpful in better understanding medications.
But the challenge is how to achieve that. Employers need more innovative, comprehensive solutions that take into account the totality of the individual – moving from focusing on the pill to the patient care process. Current approaches are largely piecemeal, failing to address the appropriate use of medications
Taking in the big picture
Employers need to think beyond the cost of individual medication. They need to consider how medications are selected, managed, and monitored. They need to know whether drug problems are being identified and addressed.
Most (55%) of those HR leaders said they offer medication adherence programs, and 53% offer chronic condition management programs and programs that steer patients toward the most effective medications. Only 46% of employers offer plans that steer patients toward the most affordable comparable medication.
Employers need a more comprehensive approach: comprehensive medication management (CMM).
Unfortunately, I’ve noticed a general lack of awareness on the part of employers about the significant impact that CMM can make on the cost and quality of care. They see the cost of specialty drugs going through the roof–with more of these expensive therapies in the pipeline. Managing and reducing drug spend is top of mind for them.
Comprehensive medication management provides the solution they seek. It is
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.[1]
CMM is a patient care service to manage those individuals with multiple chronic conditions, on multiple medications coordinating medication plans between primary care and specialists. It is, first and foremost, whole-person care.
There’s a lack of awareness of CMM in particular, of course, but more specifically, I don’t think there is a clear understanding of CMM and how it differs from medication therapy management (MTM). CMM differs from MTM in that it is a well-defined process to optimize medication use. MTM is not as well-defined or standardized and typically looks at a single strategy for drug management rather than a comprehensive, coordinated array of services. It gets back to the piecemeal approach I mentioned.
That’s compounded by the role of PBMs, which sometimes keep employers in the dark about the drug’s benefit. Too often, the lines of responsibility are blurred when it comes to managing drugs. Clear responsibilities, guidelines, and expectations should be identified in the plan design and in contracting.
Moving CMM to the forefront
CMM is a proven benefit strategy that can reduce the cost of care and improve the health of employees and their families.
We know comprehensive medication management can improve clinical outcomes and reduce health care costs.
When a patient takes the right dose of the right medication at the right time, the patient achieves the maximum beneficial impact of the medication. They experience fewer drug therapy problems– including interactions and adverse side effects.
This sounds like adherence, but it’s so much more. CMM involves finding the right medication (or combination of medications) from among all the available options–and accounting for comorbidities and other medications. It involves stopping medications that don’t work. It’s finding the right dose–high enough to be effective, but not so high that it causes toxicity. It’s making sure patients can use medication-related devices correctly, and it’s making sure the medications are accessible and affordable to the patient.
This approach improves clinical outcomes, especially in those with chronic conditions. The result: less absenteeism and fewer emergency department visits, hospitalizations, and readmissions. [2],[3],[4],[5]
However, even employers who understand the value of CMM remain unaware of how infrequently CMM is deployed. To be fair, they have had other issues to contend with: The past two years have been singularly focused on COVID-19. Plan design changes have had to take a back seat.
Now, however, employers are once again reviewing benefits, programs, and services to make sure that every healthcare dollar is well spent.
For instance, employers are becoming more interested in supporting and promoting advanced primary care for their plan members as a value-based benefit.
CMM can and should be a patient care process that is paid for through advanced primary care models. It’s not an isolated medication management tool. It’s an integrated patient care service that involves coordinating multiple conditions (and the relevant specialists). Again, we’re talking about comprehensive, whole-person care.
This growing interest in advanced primary care affords us the opportunity to educate employers on the value-added role that the clinical pharmacist plays in the healthcare team by optimizing medication use and improving patient care, patient outcomes and the patient experience.
There are other points of entry, of course. But however we do it, it’s time to make sure employers understand how CMM can help them achieve their healthcare goals.
Next steps?
Employers should do two things right away – (1) Review the GTMRx Employer Toolkit to learn more about CMM; and then (2) Reach out to their health plan and PBM partners to get the process started to ensure that CMM services are being appropriately deployed to the patients who need them most.
[1] McInnis T, Webb E, and Strand L. The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes, Patient Centered Primary Care Collaborative, June 2012
[2] Brummel, A., Lustig, A., Westrich, K., Evans, MA., Plank GS., Penso J., and Dubois RW. Best Practices: Improving Patient Outcomes and Costs in an ACO Through Comprehensive Medication Therapy Management. J of Managed Care and Specialty Pharmacy. 2014. (20): 12.
[3] The Outcomes of Implementing and Integrating Comprehensive Medication Management in Team-Based Care: A Review of the Evidence on Quality, Access and Costs, GTMRx, October 2020
[4] Brummel, A, Carlson, A. “Comprehensive Medication Management and Medication Adherence for Chronic Conditions.” Journal of Managed Care Pharmacy 2016; 22 (1); 56-62.
[5] Budlong, H, Brummel, A, Rhodes, A, Nici, H. “Impact of Comprehensive Medication Management on Hospital Readmission Rates.” Population Health Management 2018.
