Pestka et. al. in the June 2022 edition of the Journal of Managed Care and Specialty Pharmacy (JMCP) conducted a qualitative analysis of Comprehensive Medication Management (CMM).

The analysis is focused on the HealthPartners’ MTM program which allows pharmacists to conduct CMM across all business lines.  HealthPartners has been encouraging community pharmacists to conduct and paying for CMM services.  HealthPartners began the community pharmacy driven CMM services in its commercial business lines in 2010 paying pharmacists using a fee-for-service (FFS) methodology.  Internal analysis demonstrated a positive return on investment (ROI).  Based on this positive ROI, the CMM program was expanded in 2015 to augment the fee-for-service (FFS) payment methodology with a performance payment component – Partners in Excellence (PIE).  PIE provides performance based reimbursement for improving selected quality metrics as a component of conducting CMM.  HealthPartners encourages pharmacists to seek patients with modifiable drug therapy problems (DTPs), but also provides pharmacists with registries of members who the plan has identified as having DTPs.  The HealthPartners program requires pharmacists to provide CMM in accordance with the Patient Care Process for CMM guidelines.  

As the CMM program had demonstrated a positive and reliable ROI, the authors sought to understand the components of CMM program sustainability.  A semistructured group interview process was used to survey 3 key stakeholders from the plan’s PIE program.  The interviews occurred in February 2021 as the PIE program reached its 18 month mark.  From these interviews, five themes emerged

• The CMM Process
  While the stakeholders did not directly tie this theme to sustainability they noted that CMM – a process of comprehensive patient assessment, care planing and iterative patient engagement to eliminate DTPs differed from the “one and done” Medicare Part D Comprehensive Medication Reviews and Targeted Medication Review cases that pharmacists are typically provided by health plans.  As a part of this theme the stakeholders also noted that CMM affords pharmacists the discretion to select which patients they will engage, while traditional Part D MTM generally assigns pharmacists patient cases.
• Network Development
  The stakeholders noted that building a CMM program that delivers ROI requires network development.  CMM requires that community pharmacists adopt a care (vs. dispensing) workflow.  For many pharmacists the skills required for clinical care documentation and provider (CPT code billing) were either new skills to be developed or old skills that required refreshing.
• Payment Design
  Stakeholders indicated that the payment design may be a barrier for pharmacists to engage in CMM.  Pharmacists looking to begin a CMM practice and join the network would have to find a billing system in addition to their traditional dispensing system and learn the conventions of CPT and ICD-10 documentation.
• CMM Sales
  The stakeholders noted that pharmacists as a group were not “packaging” their HealthPartners CMM program success and  “selling” their CMM services to other payers.  This lack of sales activity places the sustainability of the single payer CMM program in jeopardy.
• Ongoing Facilitated Learning Collaboration
  It was noted that pharmacists do not have a ready vehicle for sharing CMM best practices.

Throughout its 15 years of operating a CMM program that has reliably demonstrated positive ROI HealthPartners key program stakeholders have identified a number of themes which managed care plans and community pharmacist providers must address to assure that the “foothold” created is sustainable and scalable. 

CSS Health has developed the Advanced Practice Network which connects payers and community pharmacy providers in programs such as Smoking Cessation, Diabetes Prevention and CMM.  The CSS MTMPath platform is a pharmacist electronic health record that provides a turn key system for pharmacy clinical documentation, tele-health and CPT code billing and payer program management and ROI evaluation.

If you’re interested in learning more about pharmacy provider programs I would be happy to set up a call to discuss.

Best – Jim
Jim Notaro, RPh, PhD
Founder and Chief Clinical Officer