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Healthcare plans are demanding more from their MTM programs evolving from a compliance offering to a population health management platform. Today MTM can identify at-risk members, improve outcomes and reduce the costs of care.

About this time in 2015, I blogged about the intersection of medication therapy management (MTM) and population health. I contended that if done correctly every medication therapy management effort should also be a population health effort, leading you deeper and deeper into a better understanding of your members and patients.

Over the last two years MTM, especially in the Medicare space, has focused so acutely on CMRs and adherence, that the potential for population health and it’s ability to create value seemed to get lost in the shuffle. However, as I travel around the country speaking to clients, especially Medicare clients, it is becoming more and more apparent that they require more value from their weighty MTM programs than just CMS and adherence are providing.

This type of value and the power of approaching MTM as a population health initiative was driven home to me just recently with one of my self-insured employer clients. At one of our quarterly meetings, we were reviewing the utilization of diabetes medication (use of the most efficient medication, use of medication above maximum daily doses, adherence, etc.). The use of diabetes medication is of increasing concern to this client – as a class if consists of one of the top five areas of spend and continues to grow. As I presented the results, the client said to me – “look, Jim, I would be a lot more comfortable with this spend if I knew what kind of value we were creating with these medications.” Seeing this as my opportunity to infuse a bit of population health into their MTM program, I suggested that as we were preparing MTM interventions for diabetic members, we include a recommendation concerning the requirements for A1C testing and requesting that prescribers provide us with the most current A1C value they had. The client agreed, and we spent the next quarter, introducing this sliver of population health into their MTM program.

After a quarter we had made the A1C request to 222 of the client’s diabetics.


A1C Status

Number (%)

Total Diabetics


A1C Received


Out of Date

21 (9.5%)

> 8

73 (32.8%)

< 8 (Good)

24 (10.8%)

Will Obtain

14 (6.3%)

No Response

90 (40.6%)


In some form, we received ~ a 60% response rate (not bad considering each prescriber only received one request). We received A1C values for ~43% of the population and identified care gaps (out of date or no A1C) in ~16% of the population.

To begin to understand what value the diabetes pharmacy spend was providing the client and their members we looked at diabetes spend by disease control (i.e., A1C below 8).


A1C Status


Total Diabetes Spend

Spend per Member

A1C > 8




A1C < 8





Interesting we found that people with diabetes with A1Cs above 8 spent ~ 2 times more (on a per diabetic basis) than people with diabetes with A1C below 8. Also, the majority of diabetics in the sample had A1C’s that were out of control, so on a gross basis, the lion’s share of pharmacy spend was being used to purchase sub-optimal diabetes care.

Indeed, one might posit a number of hypotheses for why this was happening. However, there is no question that this small population health effort built into the MTM program provided a good deal of insight into where MTM might be directed to create high value.

I am always happy to discuss the concepts of medication therapy management and population health.

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