Over 3.5 Billion prescriptions are written in the United States each year, driving a drug spend of $249 billion. These costs, which represent 10 percent of all U.S. healthcare spending, produce huge benefits including improved quality of life and reduced morbidity and mortality that go far beyond anything that can be expressed in financial terms.
However, along with these positive impacts, drug-related morbidity and mortality associated with failures of a therapeutic agent to produce a desired outcome result in additional costs estimated at $200 billion each year.
Medication Therapy Management (MTM) consists of four interlocking steps: assessing the need, prescribing, dispensing and monitoring. Comprehensive MTM refers to an advanced standard of care where the assessment element of this process includes:
- A complete account of all of a patient’s medications with directions for use
- Documentation of the intended medical purpose for each medication
- Determination of an objective and patient experience goal for the use of each medication
Research has shown that significant improvements in quality and cost savings can be realized when all of these data elements are gathered and used in a team-based care environment which includes the patient. In the study cited here, the target organization experienced 11 percent reduction in spending growth along with a 16 percent to 27 percent improvement in quality scores relative to other organizations.
The achievements cited above took place in a tightly integrated delivery system with a strong information technology infrastructure. This suggests that health information technology, when embedded with a high-performing medical care team and a culture supporting continuous quality improvement, can contribute significantly to achieving the benefits of MTM.
Supporters have adopted a new paradigm to convey this message, labeling it “eMedication Management.” eMedication Management embraces traditional models for treatment and dispensing of medications in patient care, but expands on them by leveraging clinical decision support, EHRs, personal health records, ePrescribing systems, Health Information Exchanges (HIE) and telehealth including mobile health applications and Web-based patient portals.
These components enable and support successful MTM by electronically connecting all stakeholders to each of the four steps of MTM.
Several HIEs around the country have recognized the potential for eMedication Management outside of tightly integrated delivery systems. As a result, they’re pursuing strategies to enable patient experience, quality and cost saving benefits through HIE-enabled MTM. Recently, a forward-looking HIE researched the value that would be created for health plans, Medicare and Medicaid by making pharmacist-generated comprehensive medication review and reconciliations available to all of a patient’s authorized providers via a statewide network of HIEs.
This type of innovative program can be truly transformational in a world of increasingly value-based reimbursement.
HIEs should consider MTM beyond the context of ePrescribing. Plan members, providers and other health systems stakeholders will benefit from supporting adoption of an expanded eMedication Management transaction set.
This would include:
- A complete set of current medications, immunizations and test results, coupled with use of discharge summaries and lab reports encoded as discrete data
- Electronic fill status, currently underutilized but should be adopted more widely
- ePrior authorization
- Structured and codified patient instructions (Sig)
- All of these data sets are critical to the effectiveness of eMedication Management
HIEs looking to advance the triple-aim goals of improving patient experience, quality and cost, as well as those in search of a sustainability model, should consider the value that can be generated through eMedication Management.
Point of Care Partners, “Moving ePrescribing Forward,” a Thought Paper for the Office of the National Coordinator for Health Information Technology, April 2012
 Isetts et al Managing Drug-related Morbidity and Mortality in the Patient-centered Medical Home, Medical Care Volume 50, Number 11, November 2012
Edited by Braden Becker