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AMANDA BRUMMEL, PHARMD FAIRVIEW HEALTH SERVICES HALEY HOLTAN, PHARMD, BCPS HENNEPIN COUNTY MEDICAL CENTER Medication Therapy Management (MTM) in transitions of care
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Medication Therapy Management (MTM) in transitions of … · Medication Therapy Management (MTM) in transitions of care . ... Project RED (Re-Engineered DC ... Medication Therapy

May 18, 2018

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  • A M A N D A B R U M M E L , P H A R M D F A I R V I E W H E A L T H S E R V I C E S

    H A L E Y H O L T A N , P H A R M D , B C P S

    H E N N E P I N C O U N T Y M E D I C A L C E N T E R

    Medication Therapy Management (MTM) in transitions of care

  • Series Objectives At the conclusion of this learning activity, participants will be

    able to: 1. Identify key changes and strategies that were used to reduce

    avoidable readmissions. 2. Describe how the program was developed and tools the team

    used. 3. Discuss the outcomes of the program. 4. Discuss how these best practices may be applied in their

    own organization.

  • HealthPartners Institute for Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    HealthPartners Institute for Medical Education

    designates this educational activity for a maximum of 11.0 AMA PRA Category 1 Credit(s), and 13.2 contact hours by MN Board of Nursing criteria. Physicians should only claim credit commensurate with the extent of their participation in the activity.

  • Amanda Brummel and Haley Holton have no relevant personal financial relationships to disclose and do not intend to discuss off-label or investigational uses of commercial products or devices.

  • Objectives

    Discuss medication related readmissions and 5 key areas to reduce them

    Review the MTM practice model Discuss how the MTM model may prevent

    medication-related admissions/readmissions Highlight medication related problems encountered

    during transitions of care

  • Improper medication use by patients has been estimated to cost the health system up to $290 billion a year

    Drug expenditures comprise 15.5% of healthcare premium

    This represents the third most costly component of the nations health spending behind hospital care (31%) and physician and clinical services (21%)

    Statistics

  • Current State of hospital discharges & readmissions

    > 34 million hospital discharges each year ~20 % are complicated by a post discharge adverse

    event About 2/3 are medication related

    60% could be prevented or avoided

    National Medicare 30 day readmission rate: 20% >$17 billion each year

  • Hospital Readmissions

    Hospital readmissions reduction program Beginning in 2013 higher than expected rates will

    reduce payments on all Medicare discharges Hospitals will not be paid for readmissions within 30

    days of discharge for specified conditions Initial evaluation based on heart attack, heart failure

    and pneumonia 2015 will add COPD, CABG, PTCA and other vascular categories

  • 5 key areas to reduce avoidable readmissions

    Comprehensive discharge planning Medication management Patient and family engagement Transition care support Transition communications

  • Medication Management

    Medication reconciliation Patient/family education on medications Adherence counseling Disease state management

    Where does Medication Therapy Management

    (MTM ) fit in? Transitions of Care (TOC) Post discharge follow-up

  • Medication Therapy Management Built upon the philosophy and process of

    pharmaceutical care practice

    ASSESSMENT CARE PLAN EVALUATION Ensure all drug therapy is indicated, effective, safe and convenient

    Identify drug therapy problems

    Resolve drug therapy problems

    Establish therapeutic goals

    Prevent drug therapy problems

    Record actual patient outcomes

    Evaluate progress in meeting therapeutic goals

    Reassess for new problems

    Continuous Follow-up Working in collaboration with all members of the healthcare team

    ESTABLISH A THERAPEUTIC RELATIONSHIP

  • Assessment of Drug Related Needs

    Unnecessary drug therapy? Additional drug therapy

    needed? APPROPRIATENESS

    Ineffective drug? Dosage too low? Drug interaction reducing

    efficacy?

    EFFICACY

    Adverse drug reaction? Dosage too high? Drug interaction increasing

    toxicity?

    SAFETY

    Willingness to take medications?

    Ability to take medications? COMPLIANCE

  • Who is an appropriate MTM patient?

    Patients at high risk or have frequent ED/ hospitalizations

    Chronic disease states that are not at goal/in control

    Poly-provider patients

    Poly-pharmacy (>7 medications)

    Patients with a recent change in their health/medication status- involving multiple medication changes

    Patients taking high risk medication classes

    Patient referred due to

    medication concerns/ questions

  • Program Goals of MTM

    To reduce overall health care costs

    To empower patients to take a more active role in their health.

    To improve the overall health and wellness of patients.

    Fairview Results:

    (13,283 MTM Patients, Sept 1998 Dec 2010)

    86% of patients had > 1 drug therapy problems

    53% of patients had > 3 drug therapy problems

    32% of patients had > 5 drug therapy problems

    61,946 Drug Therapy Problems Resolved

  • Basic Population Strategy

    TOC Patients

    General Population

    Chronic Disease Population

  • Add Resources

    Optimize Resource

    Use

    TOC Patients Risk Control

    High Risk

    Low Risk

    Basic Population Strategy

  • Transitions in Care

    Inpatient and Outpatient Pharmacy Services Working to reduce readmissions through improved medication management, reconciliation, and patient education

    Hospital pilot FPA/Ucare pilot CHF home visit pilot Clinic Based Pilot

    Pilot findings used to move toward a high-level model of strategic care based on patient risk of returning to hospital

  • Developing a Transitions of Care Model

    In reviewing pilots, transitional model requires:

    Timely follow-up after admission Exceptional communication and hand-offs Targeting of patients at high risk of returning to hospital Leveraging the Continuum of Care Resources Inpatient MTM Retail Specialty

  • Med Reconciliation, RPh involvement Upon admission Upon discharge Pharmacist education

    Med Reconciliation Upon admission Nursing education

    Med Reconciliation Upon admission Nursing education

    Transitions of Care Model

    Standard care by retail

    Discharge liaison involvement Follow-up call

    Verify next refill Follow-up MTM visit

    Standard care by retail If meeting criteria, MTM visit

    2 new medications >10 medications

    Referrals to any department at any level when deemed appropriate

    High Risk:

    ERG > 7

    Medium Risk: ERG 2-7

    Low Risk: ERG < 2

    Inpatient Outpatient

    ERG: Episode Risk Groups MTM: Medication Therapy Management

    Fairview Pharmacy Services

  • Project RED (Re-Engineered DC)

    Target Population: Psychiatry

    Medication Reconciliation upon discharge Clinic follow-up one week post-discharge Utilize consistent pharmacist provider Training of inpatient staff to provide MTM

    Medication education Medication reconciliation Adherence assessment

  • Enhanced Discharge Clinic

    Target Population: General Medicine Patients Discharge Advocate, RN Inclusion criteria: three or more admissions in the last year admission diagnosis of congestive heart failure, pneumonia or acute

    myocardial infarction one readmission within last 30 days

    Clinic follow-up within 5 days post-DC CNP & PharmD

    Medication reconciliation Adherence assessment Medication education Ensure appropriate drug monitoring Ongoing follow-up with MTM provider

  • Problems Encountered During Transitions of Care

    Incomplete medication reconciliation upon admission

    Inaccurate medication reconciliation upon discharge Absence of/poor discharge counseling Insurance problems preventing appropriate

    discharge medications Lack of clarification regarding follow-up plan Lack of common language

  • Planning Pearls

    Multidisciplinary team approach Defined target population Risk stratification of patients

    Enhanced communication between inpatient and outpatient

    Following the patient through the black hole

  • arhode1@fairview.org haley.holtan@hcmed.org

    QUESTIONS

  • Next Webinar

    December 14th 12:00 1:00 p.m. Home Care and Reducing Hospital Readmissions

    Speaker: Jennifer Sorensen, Minnesota HomeCare Association

    To suggest future topics for this series,

    Reducing Avoidable Readmissions Effectively RARE Networking Webinars, Contact:

    Kathy.Cummings@icsi.org

    Medication Therapy Management (MTM) in transitions of careSlide Number 2Slide Number 3Slide Number 4ObjectivesSlide Number 6Current State of hospital discharges & readmissionsHospital Readmissions5 key areas to reduce avoidable readmissionsMedication ManagementMedication Therapy Management Built upon the philosophy and process of pharmaceutical care practiceAssessment of Drug Related NeedsWho is an appropriate MTM patient?Program Goals of MTMSlide Number 15Slide Number 16Transitions in CareDeveloping a Transitions of Care ModelSlide Number 19Project RED (Re-Engineered DC)Enhanced Discharge ClinicProblems Encountered During Transitions of CarePlanning Pearlsarhode1@fairview.orghaley.holtan@hcmed.orgSlide Number 25