Medication Therapy Management (MTM) for seniors, particularly those taking multiple drugs for complex medical problems, may be the single best way to avoid unnecessary complications and hospitalizations in the Medicare population. A 2011 study of adults over 65 years of age found that 265,000 emergency department visits resulted in 99,628 hospitalizations as a direct result of medication errors.1
This study, and others like it, shine a light on the challenge the health care industry faces to adequately document seniors medications and ensure those medications are taken appropriately.
Knowing what medications Medicare beneficiaries are taking is not only difficult for health plans but also for treating physicians. As a health plan, if a member has Part D coverage through your plan, you at least have access to their prescription claims (PDEs); but even then, you are only seeing a small piece of the picture. What about all the medications they might have that do not trigger claims, like: over the counter (OTC) drugs, herbal medications, $4 generics from Wal-Mart, medications obtained from the Veterans Health Administration (VA), samples from their physician’s office; and drugs obtained from neighbors, friends and family members. For Primary Care Physicians (PCP), knowing what medications their patients are taking is equally challenging. Although they should know everything their patients are taking, they really only know what they’ve prescribed and what the patient tells them they are taking. Plus, take into consideration that the member’s PCP isn’t the only doctor they’re seeing. The average Medicare member sees just over 5 physicians and has 7.1 active charts2
, which means it’s nearly impossible to have an individual’s medication information collected in one place.
There is a solution – collect this data in the home. When a CenseoHealth CareConsult™ home visit is scheduled, we request that the member put all their current medications on the kitchen table. When the physician arrives, the CareConsult™ form has the member’s Part D claim data pre-populated. From there the physician confirms if the member is taking the medications identified in claims, if they know what they are taking them for, and what medications the member is taking that is not in claims.
Using CenseoHealth’s Medication Therapy Management service, we can run this data through our advanced pharmaceutical analytics software that compares the Comprehensive Medication Review (CMR) data against the Beer’s List; identifying if the member is taking two drugs of the same class and if any of the drugs may cause drug-drug or drug-disease interactions. Immediately following, we generate a Medication Action Plan (MAP) to the member and the member’s PCP providing a complete and accurate medication list and identifying potential problems.
Everyone benefits from the unique opportunity afforded by an in-home evaluation, especially when it comes to MTM. Members can ask questions about the medications they’re taking and get advice about possible problems; the PCP gets an accurate medication list; and the health plan gets the information necessary to submit both their annual CMR and MAP to CMS, while driving MTM related Star Rating measures. CenseoHealth’s MTM is just one more example of how Medicare Advantage can benefit seniors in a way that is not possible in traditional Medicare.
about CenseoHealth's Medication Therapy Management service.
Budnitz, DS et al, Emergency Hospitalizations for Adverse Drug Events in Older Americans, NEJM
Chronic Conditions: Making the Case for Ongoing Care Partnership for Solutions, Partnership for
Solutions, Johns Hopkins Univ. 2002.