Florida QIO developing report card on MTM

February 19, 2007

Seeking to provide hard data on the efficacy and impact of medication therapy management (MTM) sessions, a Florida Quality Improvement Organization (QIO) is studying the MTM results of Humana and AvMed Medicare patients in that state. The Florida Medicare Quality Improvement Organization (FMQAI) is working with the two prescription drug plans (PDPs) and pharmacists to set up the programs and educate patients and will publish its results in late 2007. FMQAI is the third-largest QIO in the country and has the second-largest beneficiary population.

Seeking to provide hard data on the efficacy and impact of medication therapy management (MTM) sessions, a Florida Quality Improvement Organization (QIO) is studying the MTM results of Humana and AvMed Medicare patients in that state. The Florida Medicare Quality Improvement Organization (FMQAI) is working with the two prescription drug plans (PDPs) and pharmacists to set up the programs and educate patients and will publish its results in late 2007. FMQAI is the third-largest QIO in the country and has the second-largest beneficiary population.

The Medicare Modernization Act mandated the Centers for Medicare & Medicaid Services to work with QIOs nationwide to improve the quality of health care for Medicare beneficiaries. QIOs are required to work with healthcare providers as well as PDPs on a variety of fronts. In addition to studies of MTM and other quality-improvement measures, QIOs are tasked with rooting out fraud and investigating quality-of-care complaints.

According to Savi Lenis, Pharm.D., senior project coordinator for FMQAI, the study will examine the success of the MTM programs from a variety of standpoints. One question will be which model seems to work best. The AvMed program is open to all Medicare beneficiaries and uses technology from Outcomes Pharmaceutical Health Care, while Humana is using its own software and has more restrictive requirements for participation.

Amid decreasing reimbursements from Medicaid and increased competitive pressure on generic drug pricing, many industry observers are pinning their hopes on MTM to provide a way forward for the industry. "It's critical to the entire profession that pharmacists do whatever is necessary to participate in the Part D MTM program," Bruce Roberts, executive VP/CEO of the National Community Pharmacists Association, told attendees of the 2006 NCPA convention. "Folks we can do this-and we must! We have a lot of eyes on our profession just waiting to see if we can deliver on MTM services."

Many pharmacists appear to be heeding Roberts' call. According to Lenis, reactions to the FMQAI MTM programs varied, but most of the state's pharmacists have been interested in getting involved. "Many of the pharmacies are very excited," she said.

Not only changing public perceptions, but driving the change to more MTM-type services was a key consideration for Miami-based Navarro Discount Pharmacies when it decided to get involved in the FMQAI program. Since the 20-unit chain has been actively discussing disease management with its patients for six years, it was well equipped to take on MTM. Many of the stores have either a clinic or a consultation room for MTM sessions.

"In the future, pharmacy will be different from what it is today," explained Carlos Ruiz, director of pharmacy for Navarro. "Pharmacists can make a difference by performing these services. The way things are going, you won't be able to stay in business without offering MTM-type services. For years, we've relied on getting paid for providing a drug."

Ruiz hopes that the FMQAI data will help convince CMS and PDPs of the importance of pharmacy services like MTM. "What is extremely important to us is that the QIOs are creating a report card to CMS," he added. "Unless we are able to demonstrate that these services are of value to the patient and the health plans, CMS will eventually stop paying or give it to someone else."

The name of the game is quality

Each state, territory, and the District of Columbia has a Quality Improvement Organization (QIO) that is working with consumers and physicians, hospitals, and other caregivers to make sure patients get the right care at the right time, particularly patients from underserved populations. The following Web sites offer more information about QIOs and their pharmacy-related initiatives: