Learn how to explain MTM and its importance
Learn the differences in the Mirixa and OutcomesMTM platforms
Learn how to create a system of policy and procedures for the pharmacy
Learn options for creating organizational systems
Learn best practices for documentation and making recommendations
Identify resources for clinical guideline recommendations and continuing education
4. Objectives
● Learn how to explain MTM and its importance
● Learn the differences in the Mirixa and OutcomesMTM platforms
● Learn how to create a system of policy and procedures for the pharmacy
● Learn options for creating organizational systems
● Learn best practices for documentation and making recommendations
● Identify resources for clinical guideline recommendations and continuing
education
6. Medication Therapy Management (MTM)
Designed to be a patient-centered service that optimizes patient outcomes by
assessing the medications used, proper use and adherence of those
medications, addressing potential gaps in therapy, identifying barriers to
optimal outcomes and other aspects affecting patient therapy.
7. Centers for Medicare and Medicaid Services (CMS)
CMS is a part of the Department of Health and Human Services that
implemented requirements that Part D sponsors must establish an MTM
program that:
Ensures optimum therapeutic outcomes for targeted beneficiaries
through improved medication use
Reduces risk for adverse events
Developed in cooperation with licensed and practicing pharmacists and
physicians
8. ROI for Pharmacy
● Increased number of fills by improved adherence
○ It has been shown through improving adherence on 1 prescription, a phar
the number of refills by an average of 3 fills per medication per year.
● Filling gaps in care generates additional revenue due to new
prescriptions
● Administering needed immunizations
9. ROI for Pharmacy (continued)
● Selling needed OTC products or DME products
● Increased traffic flow and selling more front end items
● Pharmacy receives reimbursement for MTM services
● Customer loyalty
○ Patients refer new patients through word-of-mouth marketing
○ Patients appreciate being part of decision making regarding therapy
10. ROI for Pharmacy (continued)
● New Clinical Programs or Collaborative Practice Agreements
● Medication Synchronization
○ Increased number of refills per year
○ Improves adherence = better performance measures
● Immunizations
○ Recommendations and administering of vaccines
● Cash pay services
○ Follow up TMR’s, diet counselling, smoking cessations, etc.
● Appointment based screenings/POC testing
○ Point of care testing services such as bone density screenings or pharmacogenomic
testing
○ Additional BP/lipid/A1C screenings to assess response to therapy
11. 2016 Star Measures: Pharmacy’s Impact
● High Risk Medications (3 points)
● Medication Adherence for Diabetes Medications (3 points)
● Medication Adherence for Hypertension (3 points)
● Medication Adherence for Hyperlipidemia (3 points)
● MTM Program Completion Rate for CMR (1 point)
12. Pharmacy Evaluation
● Collecting data
○ EQuiPP scores
○ PrescribeWellness
● High/low performing pharmacies
○ Outcomes based payment models
○ Subject to DIR fees
● Preferred pharmacy networks
○ Higher STAR PDPs working with better performing pharmacies
13. Direct and Indirect Remuneration (DIR) Fees
● “Pay to play” fees for network participation
● Periodic reimbursement reconciliations
● Payment/fee mechanism associated w/ performance of quality measures
● Cannot be determined at Point of Sale
15. Outcomes Based Reimbursement
● Pay for performance
● Value-based purchasing
● Rewards high performance
● Penalizes poor outcomes
○ Excluded from “preferred network” of pharmacies
○ Pharmacies with low STAR ratings risk losing contracts with select insuranc
not able to bill for prescriptions
17. Mirixa
● 21- 28 day window to complete interventions
● “Flags”
○ Red - safety
○ Blue - adherence/care gap
● CMR can be over the phone; face-to-face is still preferred
● Assigned alerts must be acted upon within 10 days or you risk losing the
intervention
○ Lost cases = lower STAR ratings
18. Getting Contracted
MirixaPro℠
● Fax in authorized user requests (MTM Leads)
● Call for login/password from pharmacy’s landline
Phone: 866-218-6649
Email: support@Mirixa.com
Web form: https://app.mirixa.com/MirixaPro/ContactSupport.aspx
19. Flags and Examples
● Blue (Care Gap)
○ Diabetic patient not on statin therapy
● Red (Safety)
○ Potential drug-drug or drug-disease interaction
○ Potential therapeutic duplication
● Green (Interchange)
○ Potential cost savings opportunity
20. CMR Delivery
● May request labs from PCP prior to appointment
● Can be via phone
○ Homebound or LTC patients
● Face-to-face is recommended
○ Ask patient to bring all of their medications into the pharmacy including OTC and
supplements
■ Use the opportunity to removed outdated or d/c’d medications from their home
● Very extensive process
○ Takes all patient conditions and goals into account
21. OutcomesMTM
● Expires at the end of the year
○ Patient may show up in queue at multiple pharmacies
○ Delay in intervention may result in lost patient cases
● “Primary” patients are shown
○ Also shows any pharmacy the patient has filled at in past 12 months
● TIPS for adherence and safety
○ Quarterly adherence checks for targeted patients
○ Medication Synchronization opportunities
● Some plans require CMR to be face to face unless prior authorization is
obtained
● RPh-Initiated TIPS are also possible
23. Targeted Intervention by Pharmacist (TIP)
● Adherence checks
● Missing therapy
● Potentially inappropriate or suboptimal drug
○ Included those “high risk” or BEERs list medications
24. Pharmacist-initiated TIPs
● Can submit for your own interventions
● If pharmacist identifies a problem not yet recognized by platform, they
can submit a Pharmacist-initiated TIP
○ Patient underuse
○ Cost-efficiency
○ Adverse reaction
○ Unnecessary drug
25. OutcomesMTM Adherence Monitoring
To earn the year-end bonus:
● Successfully complete all Adherence Monitoring services throughout the
year, AND
● Help the patient achieve a >80% adherence rate at year-end.
26. CMR Delivery
● May request labs from PCP prior to appointment
● Must be face-to-face or telehealth
○ Unless plan allows for phone delivery
○ Can be delivered to caregiver, nurse, family member
● LTC patients can speak to a nurse
● More and more plans are allowing phone CMRs
