Improving Patient Outcomes: M&Ms,

MTM and CMMRoy Goo, PharmD

Associate Professor, Pharmacy Practice

Grant Collaboration• Hawaii Department of Health

• Mountain-Pacific Quality Health

• The Daniel K. Inouye College of Pharmacy:University of Hawaii at Hilo

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1.0 AMA PRA Category 1 credits™

This activity has been planned and implemented with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the Hawai’i Consortium for Continuing Medical Education (HCCME) and Mountain-Pacific Quality Health. The Hawai’i Consortium for Continuing Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Hawai’i Consortium for Continuing Medical Education designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participation & Evaluation• Evaluation survey for webinar• You must participate in the entire activity and fill out

the evaluation to receive CME credit• For CME credit, take note of the MTM - CME

passcode at the end of the evaluation• If you requested CME credit at registration you will

receive an email with a link to request CMEcertificate

• If you have any questions regarding CME creditemail, follow up with cbarton@mpqhf.org

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Polling question 1Is your primary place of practice a:• Solo private practice• Small group practice (three full-time licensed practitioners or

fewer, including APRNs, NPs, and PAs)• Large group practice (four or more full-time licensed

practitioners, including APRNs, NPs, and PAs)• Federally Qualified Health Center (FQHC)• Hospital-based clinic• Military-based clinic• Other _______________________• Not a practice

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Financial DisclosuresNo financial relationships to disclose:

• Roy Goo, PharmD – Speaker

• Carl Barton – Introduction & planning committee

• Dr. Ranjani Starr – Planning committee

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Learning ObjectivesBy the end of this session you should be able to:

• Apply MTM model of Comprehensive MedicationManagement (CMM) in clinical practice

• Utilize MTM (CMM) reimbursement for adopting asustainable practice integration model

• Apply MTM / CMM model in clinical practice, formulateand execute collaborative care agreements

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Medication-Related Problems

• Approx. 1/3 of adults take ≥5 medications• 5% of all hospitalized patients will

experience an Adverse Drug Event • 1.5 million preventable medication-related

adverse events/ Year• Over $200 billion in medication related

morbidity and mortality

https://psnet.ahrq.gov/primers/primer/23/medication-errors

Medication Therapy Management

Definitions• MTM = Medication Therapy Management

– Defined following the Medicare Prescription DrugImprovement and Modernization Act (2003)

• CMM = Comprehensive MedicationManagement– First Described by Patient Centered Primary Care

Collaborative (2010) in the context of PatientCentered Medical Homes

• M&Ms– Colorful button shaped chocolates produced by

Mars Wrigley Confectionary (1941)

M&Ms • M&Ms may aid in faster and more accurate

identification of medication-related problems

No. of ConditionsCorrectly Identified

Candy (n=15) Control (n=15)

0 to 1 8 132 to 3 2 14 to 5 3 06 to 7 2 1

Estrada CA, Isen AM, Young MJ. Positive Affect Improves Creative Problem Solving And Influences Reported Source of Practice Satisfaction in Physicians. Motivation and Emotion. 1994. Vol 18 (4): 285-299

MTM & CMM

2018 (Q4)

Implementation of CMM (CPC +)

CDTM= Collaborative Drug Therapy Management

What is MTMGOALS

• ImproveInterdisciplinaryCollaboration

• Enhancecommunicationbetween patients andtheir healthcare team

• Optimize medicationuse

• Improve patientOutcomes

What is MTM• Distinct from

medication dispensing

• Patient Centered NOT Product Centered

• Empower patients to take an active role in medication management

Barriers to effective provision of MTM/ CMM Services• Reservations about pharmacists serving in

a non-dispensing capacity• Lack of understanding regarding

relationship between prescriber and MTMservice

• Variations in acceptance ofrecommendations

MTM: Core Elements

• Medication Therapy Review (MTR)• Personal Medication Record (PMR)• Medication-related action plan (MAP)• Intervention and/or referral• Documentation and follow-up

* MTM does NOT require a formal collaborative practice agreementbetween pharmacist and prescriber

Medication Therapy Reviews

• A systematic process of:– Collecting Patient-Specific Information– Assessing Medication Therapies– Identifying and Prioritizing Medication-

Related Problems

Medication Therapy Reviews

Comprehensive MTR• All current medications

are evaluated (includingnonprescriptionmedications &supplements)

• Identifies presence ofmedication-relatedproblem

Targeted MTR• Target specific

medication-relatedproblem

• Ideally performed after acomprehensive MTR

Polling question 2Are you interested in including a pharmacist in your practice?• Yes, we already engage a pharmacist on our team• Yes, in the next 6 months• Yes, in the next 1-2 years• Yes, in the next 2-5 years• I am not sure • No, I am not interested• Not a practice

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Minnesota Experience • Objectives

– Measure Clinical Effects Associated with MTM– % obtainment of HEDIS goals for HTN and

HLP– Compare Total Health Expenditures

• Intervention– One-year study period– At last one initial and one follow-up encounter– Pharmacist Imbedded in Clinic

Major Barrier to provision of MTM services= CMR completion rates

Intervention Group: 71% met HEDIS 2001 criteria for HTN vs 59% in control group (p=0.03)

Total Cost of MTM services : $49,490 ($266.08/ patient)

Payers in Healthcare

Chart1

Commercial

Medicare

Medicaid

Other

Payers

0.5

0.3

0.07

0.13

Sheet1

Payers

Commercial50%

Medicare30%

Medicaid7%

Other13%

To resize chart data range, drag lower right corner of range.

Medicare

• Medicare Part A– Improvement of Quality Measures (i.e.

Hospital readmission rates)• Medicare Part B

– MACRA – Quality Payment Program (QPP) Pharmacists considered “auxiliary staff” Aid in obtainment of MIPS measures

MACRA- MIPS

• MIPS score– 50% for quality (PQRS/VBM)– 25% or Meaningful use– 15% for clinical practice improvement– 10% for resource use

MACRA- MIPS• MIPS score: Quality

– #01- Diabetes: HbA1c> 9%– #236 - Hypertension: BP< 140/90 mmHg– #373 - Hypertension: BP Improvement– #05:HF- ACEI or ARB for LVSD– #07: CAD - BB Therapy– #09: Anti-Depressant Medication Management– #46: Medication Reconciliation Post Discharge

Hypertension, Outcome: Systolic BP# Design Groups Sample Size Pre- Post- Change(mm Hg)

1 Cluster-randomized controlled clinical trial lasting 6 months; 3 one-to-one encounters, with numerous telephone sessions throughout

Intervention 192 153.6 132.9 -20.7

Control 210 150.6 143.8 -6.8

2 Average follow-up of 5 months/patient; unknown # of interventions Intervention Unknown 156.5 144.5 -12.0

Control Unknown 153.7 151.0 -2.7

3 Randomized controlled trial, 12 month studyBaseline, encounters every 4 months (4 encounters)

Intervention 120 131.4 127.2 -4.2

Control 120 132.6 132.1 -0.5

4 Randomized controlled trial; 12 month studyIntervention at baseline, 6 months; 6 telephone sessions

Intervention 99 157.0 143.0 -14.0

Control 99 156.0 149.0 -7.0

5 Randomized controlled trial;12 monthsInitial encounter, then every 2 weeks until BP controlled

Intervention 237 152.2 137.9 -14.2

Control 247 151.9 146.3 -5.3

6 Randomized controlled trial; 6 monthsInitial at baseline, then every 2 months (4 encounters)

Intervention 83 133.4 124.4 -6.9

Control 176 135.0 133.3 -1.0

7 Randomized controlled trial; 6 months; Baseline encounter, subsequent meeting as needed (determined by self-uploaded BP reading to website); final person-to-person at end of study.

Intervention 175 148.8 128.1 -20.7

Control 173 145.5 137.1 -8.1

Controlled

Uncontrolled

References: HTN1. Carter, Barry L., et al. "Physician and pharmacist collaboration to improve blood pressure

control." Archives of internal medicine 169.21 (2009): 1996-2002.2. Erickson SR, Slaughter R, Halapy H. Pharmacists’ ability to influence outcomes of

hypertension therapy. Pharmacotherapy. 1997;17:140–1473. N.R. Al Mazroui, M.M. Kamal, N.M. Ghabash, T.A. Yacout, P.L. Kole, J.C. McElnay

Influence of pharmaceutical care on health outcomes in patients with type 2 diabetes mellitus British Journal of Clinical Pharmacology, 67 (5) (2009), pp. 547–557

4. R.M. Clifford, K.T. Batty, T.M.E. Davis, W. Davis Effect of a pharmaceutical care program on vascular risk factors in type 2 diabetes: The Fremantle Diabetes Study Diabetes Care, 28 (4) (2005), pp. 771–776

5. Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, Carrell D, Tyll L, Larson EB, Thompson RS. Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA. 2008;299:2857–2867

6. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296:2563–2571.

7. Magid DJ, Olson KL, Billups SJ, Wagner NM, Lyons EE, Kroner BA. A pharmacist-led, American Heart Association Heart360 Web-enabled home blood pressure monitoring program. Cir Cardiovasc Qual Outcomes. 2013;6:157–163.

Diabetes, Outcome: HbA1c# Design Groups Sampl

e SizePre- Pos

t-Change(%)

1 Randomized controlled trial, 12 months. Initial consultation, followed by quarterly follow ups (4 encounters)

Intervention

120 8.5 6.9 -1.6

Control 120 8.4 8.3 -0.1

2 Randomized controlled trial, 12 months. Encounters at baseline, 6 month, and 12 months (with 6 telephone sessions; 9 total)

Intervention

99 7.5 7.0 -0.5

Control 99 7.1 7.1 -0.0

3 Randomized controlled trial, 12 months.Encounters at baseline, 6 months, and 12 months (telephone appointments)

Intervention

99 11.0 8.5 -2.5

Control 95 11.0 9.4 -1.6

ControlledIntermediateUncontrolled

References - Diabetes1. H.M. Choe, S. Mitrovich, D. Dubay, R.A. Hayward, S.L. Krein, S.

Vijan Proactive case management of high-risk patients with type 2diabetes mellitus by a clinical pharmacist: a randomized controlledtrial American Journal of Managed Care, 11 (4) (2005), pp. 253–260

2. R.M. Clifford, K.T. Batty, T.M.E. Davis, W. Davis Effect of apharmaceutical care program on vascular risk factors in type 2diabetes: The Fremantle Diabetes Study Diabetes Care, 28 (4)(2005), pp. 771–776

3. R.L. Rothman, R. Malone, B. Bryant, A.K. Shintani, B. Crigler, D.A.Dewalt, et al. A randomized trial of a primary care-based diseasemanagement program to improve cardiovascular risk factors andglycated hemoglobin levels in patients with diabetes. AmericanJournal of Medicine, 118 (3) (2005), pp. 276–284

•

Diabetes Self-Management TrainingHCPCS CodeG0108 Individual Diabetes Management

Training (per 30min unit)G0109 Group Session Diabetes Training (per

30min unit)

• A minimum of two units must be billed at a time• Pharmacist must be a certified CDE OR program must be accredited

through ADA• Services must be furnished in an environment conducive to adult learning• Covered Services

• 10 hours of initial training (Year One)• Two years of follow-up training (subsequent years)

MACRA MIPS

• Clinical Practice Improvement– Population Management Anticoagulant Management Improvements Glycemic Management Services

– Patient Safety and Practice Assessment Implementation of an ASP

Effect of Centralized Clinical Pharmacy Anticoagulation Service

Witt DM, Sadler MA, Tillman DJ, et al. Effect of a Centralized Clinical Pharmacy Anticoagulation Service on Outcomes of Anticoagulant Therapy. Chest. 2005; 127: 1515-1522

Effect of Centralized Clinical Pharmacy Anticoagulation Service

Witt DM, Sadler MA, Tillman DJ, et al. Effect of a Centralized Clinical Pharmacy Anticoagulation Service on Outcomes of Anticoagulant Therapy. Chest. 2005; 127: 1515-1522

Effect of Centralized Clinical Pharmacy Anticoagulation Service

Witt DM, Sadler MA, Tillman DJ, et al. Effect of a Centralized Clinical Pharmacy Anticoagulation Service on Outcomes of Anticoagulant Therapy. Chest. 2005; 127: 1515-1522

Medicare Part D • CMS will pay Prescription Drug Plans to

provide MTM services for their members• Patient must have :

– ≥3 chronic conditions

– Taking ≥8 Medicare Part D drugs– Total Cost of Drugs ≥$3,967 / year

Asthma Chronic Heart FailureCOPD DepressionCardiovascular Disorders OsteoporosisDiabetes

Example of Cover Letter

Fee-for-Service Billing Options• Evaluation and Management (E&M) CPT

Codes– Pharmacists = Auxiliary Personnel– “Incident-to” (99211-99214)

Physician Office PFS Billing Options CPT Billing CodesIncident – to: Physician 99211-99215Incident - to: Transitional Care Management (TCM)

99496 ( within 7 days of discharge)99495 (within 14 days of discharge)

Incident - to: Complex Chronic Care Management (CCM)

99490 (20min per month99487 (60min per month)99489 (each additional 30 min)

Diabetes self-management training G0108 (individual-30min/unit)G0109 (Group- 30min/unit)

Incident-to billing• Documentation Requirements Assessments of Care

N/A Problem Focused Expanded Problem Focused

Detailed Comprehensive

Decision Making N/A Straightforward Low Moderate High

E&M Code 99211 99212 99213 99214 99215

HPI N/A Brief (1-3 elements)

Brief (1-3 elements)

>4 elements >4 elements

ROS N/A N/A Problem pertinent 2-9 elements > 10 elements

Family and Social History

N/A N/A N/A Pertinent or 1 item from any of the areas

1 element from 2 or 3 of the 3 categories

Physical exam N/A 1-5 elements in ≥ 1 system

>6 elements in ≥ 1 system

2 elements in 6 organ systems

2 elements in 9 organ systems

Time involved 5 10 15 25 40

Incident-to billing• Direct Supervision

– Supervising Provider must be in the same office suite– Does NOT apply to TCM or CCM

• Services provided only to established patients • Services must be documented as medically

necessary • Evidence that supervising provider is continuing to

direct the plan of care (visits do not replace regular physician visits although frequency may change)

Transitional Care

• Component (Delivered over a 30-day window)– Interactive Contact (within two business days)– Non - Face-to-Face Services May be performed under “General Supervision”

– Face-to-Face Visit May be performed under “Direct Supervision”

Non-Face-to-Face Services• Obtain and review discharge Information• Review need for follow-up on pending diagnostic

tests/treatments• Interact with other health care professionals who

will assume care • Provide education• Assist in scheduling required follow up

appointments• Assess and support treatment regimen

adherence and medication management

Transitional Care

Phatak A, Prusi R, Postelnick M, et al. Impact of pharmacist involvement in Transitional Care of High Risk Patients Through Medication Reconciliation, Medication Education, and Postdischarge Call-Backs (IPITCH Study). J Hosp Med. 2016; Jan 11(1): 39-44

Chronic Care Management

• Requirements– ≥ 2 chronic conditions

– Chronic conditions place the patient at significant risk of death, acute exacerbation, decompensation or functional decline

Alzheimer's disease Autism Spectrum Disorder

Hypertension

Arthritis Cancer Cardiovascular DiseaseAsthma Depression COPDAtrial Fibrillation Diabetes Chronic Infectious

Diseases

Chronic Care Management• Service Summary

– Initiating visit (with one year of commencement of CCM services)

– 24/7 Access & Continuity of Care– Comprehensive Care Management– Comprehensive Care Plan– Management of Care Transitions– Home and Community-based Care Coordination– Enhanced Communication Options– Patient Consent – Medical Decision-Making

Chronic Care Management

• Applicable Billing Codes– CPT 99490 (At least 20 min.)– CPT 99487 (> 60 min.) – CPT 99489 (Additional 30 min.) Add on to 99487

Chronic Care Management

• Core Activities– Recording Structured Data in the Patient’s

Health Record– Maintaining a Comprehensive Care Plan – Providing 24/7 Access to Care– Comprehensive Care Management– Transitional Care Management

Role of Pharmacist in CCMPhysician Pharmacist Non-Clinical Staff

Patient Consent XCollect Structured Data

X X X

DevelopComprehensive Care Plan

X

Maintain/Update Care Plan

X X

Manage Care X XProvide 24/7 Accessto Care

X X

Document Services X XProvide Support Services

X X

Comprehensive Primary Care Plus (CPC +)• Advanced Primary Care Medical Home

Model• Three Payment Elements

– Care Management Fee (CMF)– Performance-Based Incentive Payments – Payment under the Medicare Physician Fee

Schedule Track 1: Medicare FFS Track 2: Reduced FFS + Comprehensive Primary

Care Payments

Timeline for integration of CMM

Quarter 12018

Quarter 2 2018

Quarter 3 2018

Quarter 4 2018

Year 3 (2019)

Identify resources and personnel to implement medication management for patients discharged from hospital and those receiving longitudinal care management

Design and Test Workflowof CMM integration

IntegrateCMM in specific CPC + Populations (i.e. high risk)

Implement CMM into practice

CMM Targeted Medication Reviews

Patient EducationDisease

Management/ Coaching

MTM

Comprehensive Medication Management (CMM)• Fully integrated with the Patient Centered

Medical Home (PCMH) Team – Delivered directly to a specific patient– Must be systematic and comprehensive – Must be coordinated with other PCMH team

members• “Whole Patient Focused” • Requires a Collaborative Practice Agreement

(CPA) that spells out roles and responsibilities

Comprehensive Medication Management (CMM)

Example of CPA – General

A physician referral is entered for the patient to be seen in the Aloha CMM Clinic, inwhich a pharmacist will manage the patient’s hypertension, hyperlipidemia and/ordiabetes mellitus type 2 according to protocol.

– In order for the patient to be accepted by the CMM Clinic, the managing physician must havesigned the collaborative agreement (see Comprehensive Medication Management ProgramCollaborative Agreement)

– Patients may be enrolled by the following methods:» Referral from managing primary care physician (PCP) for, but not limited to, patients with

uncontrolled hypertension, hyperlipidemia and/or diabetes mellitus type 2 requiringcomplex medication regimens to the CMM Clinic for medication and disease stateeducation, monitoring of adverse drug reactions and medication adjustment to improvedisease control.

» Patients recently discharged from the hospital due to medication adherence under thecare of a participating Straub PCP.

– Enrollment preference will be given to patients who are not at their optimized blood pressure,lipid and/or glycemic goal and to those who demonstrate poor adherence to their prescribedmedication regimens.

– When a physician referral is entered for the patient in the Aloha CMM Clinic, the pharmacist willassist the physician to educate and manage the patient’s hypertension, hyperlipidemia and/ordiabetes mellitus type 2.

Pharmacists executing this protocol must have successfully completed the competencyrequirements.

Example of CPAMonitoring

Baseline and follow-up laboratory values, and monitoring– Hypertension

» Blood pressure for all patients at each visit (i.e., initial visit and follow-up). Additionallabs based on the individual medication therapy will be monitored.

– Hyperlipidemia» Baseline lipid panel will be performed at initial visit. Lipid panel taken at or less than 3

months of initial visit may be considered baseline based on clinical judgment. Additionallabs based on the individual medication therapy will be monitored.

» Statin therapy (Refer to Appendix 13)» Non-statin therapy (Refer to Appendix 14)

– Diabetes Mellitus Type 2» Blood glucose for all patients at each visit and hemoglobin A1C according to glycemic

stability (i.e., initial visit and follow-up). Additional labs based on the individual medicationtherapy will be monitored. (Refer to Appendix 18)

– Follow-up monitoring will be based on guideline recommendations and clinical judgment. All abnormal laboratory results will be forwarded to the managing physician for

subsequent action. All critical laboratory results will immediately be forwarded to themanaging physician for subsequent action according to the Straub’s Critical Test andCritical Results Policy and Procedures.

Subsequent pharmacist follow-up can occur via clinic appointment or telephone basedon the specific needs of the patient.

Example CPA– Initial Medication

Initial choice of therapy to achieve target goals will be determined by patient-specific factors, concomitant disease states, medication availability, cost and potential side effects. (Hypertension: refer to Appendices 1-5, Hyperlipidemia: refer to Appendices 6-18, Diabetes Mellitus Type 2: refer to Appendices 19-26).

Initial doses for each medication will be based on standard dosage recommendations and patient renal/hepatic function (Reference: Lexicomp).

Add-on medication therapy is based on assessment of medication adherence, appropriateness of therapy, intolerance, and reaching target goals.

Based on clinical judgment, the pharmacist will confer with the managing physician when needing to refer the patient to a specialist (e.g., endocrinologist, cardiologist).

Appendix: Monitoring

• A1C Testing– Perform the A1C test at least two times a year

in patients who are meeting treatment goals (and who have stable glycemic control) (E)

– Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals (E)

Appendix: Treatment Goals

A1C Goal Recommendation

Appendix: Initial Therapy

Initial Therapy

• Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacological agent for type 2 diabetes (A)o If patients with metformin intolerance or contraindications, consider an

initial drug from other classes (i.e. sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, basal insulin)

• In patients with newly diagnosed type 2 diabetes and markedly symptomatic and/or elevate blood glucose levels or A1C, consider initiating insulin therapy (with or without additional agents) (E)

• A patient-centered approach should be used to guide choice of pharmacological agents. Considerations include efficacy, cost, potential side effects, weight, comorbidities, hypoglycemia risk, and patient preference (E)

Combi-nation Therapy

• If noninsulin monotherapy at maximum tolerated dose does not achieve or maintain the A1C target over 3 months, add a second oral agent, a GLP-1 receptor agonist, or basal insulin (A)o Oral agents include sulfonylureas, thiazolidinediones,DPP-4 inhibitors, SGLT2

inhibitors• For all patients, consider initiating therapy with combination therapy when A1C ≥9%• Due to the progressive nature of type 2 diabetes, insulin therapy is eventually indicated

for many patients with type 2 diabetes (B)• Consider initiating combination insulin therapy when blood glucose is ≥ 300-350 mg/dL

and/or A1C is ≥10-12%

Example of CPA – Physician Notification Patients with elevated blood pressure and who are

symptomatic (according to JNC guidelines), elevated blood glucose and who are symptomatic (according to ADA Guidelines), primary physician will be contacted for further action or sent to the Emergency Department if necessary. The physician will be contacted if patients

experience serious side effects (i.e., myopathy to statin therapy).

Comprehensive Primary Care Plus (CPC +)• Quality Reporting

– Must report 9 out of 19 MeasuresMeasure Measure type Domain

Controlling High Blood Pressure Outcome Effective Clinical Care

Diabetes: HbA1c > 9% Outcome Effective Clinical Care

Use of high risk medications in the elderly

Process Patient Safety

Preventative Care and Screening : Tobacco Use

Process Patient Safety

Ischemic Heart Disease: Use of ASA or another antiplatelet

Process Patient Safety

Statin therapy for prevention and treatment of Cardiovascular Disease

Process Patient Safety

References 1. “ Chronic Care Management (CCM): An overview for pharmacists”.

https://www.pharmacist.com/sites/default/files/CCM-An-Overview-for-Pharmacists-FINAL.pdf. Accessed 5/7/18

2. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf. Accessed 5/1/18

3. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf. Accessed 5/1/18

4. https://www.accp.com/docs/positions/misc/CMM%20Brief.pdf. Accessed 4/30/185. https://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practi

ce.pdf. Accessed 4/30/186. https://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Resources/InstantDownlo

ads/DSMT_Guidebook_508c.pdf. Accessed 5/7/187. https://www.cms.gov/Medicare/Prescription-Drug-

Coverage/PrescriptionDrugCovContra/Downloads/A-Physician%E2%80%99s-Guide-to-Medicare-Part-D-Medication-Therapy-Management-MTM-Programs-08242017.pdf. Accessed 4/30/18

https://www.pharmacist.com/sites/default/files/CCM-An-Overview-for-Pharmacists-FINAL.pdfhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdfhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdfhttps://www.accp.com/docs/positions/misc/CMM%20Brief.pdfhttps://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf.%20Accessed%204/30/18https://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Resources/InstantDownloads/DSMT_Guidebook_508c.pdfhttps://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/A-Physician%E2%80%99s-Guide-to-Medicare-Part-D-Medication-Therapy-Management-MTM-Programs-08242017.pdf

Questions?

Improving Patient Outcomes: M&Ms, MTM and CMMGrant Collaboration1.0 AMA PRA Category 1 credits™Participation & EvaluationPolling question 1Financial DisclosuresLearning ObjectivesMedication-Related Problems Medication Therapy ManagementDefinitionsM&Ms MTM & CMMWhat is MTMWhat is MTMBarriers to effective provision of MTM/ CMM ServicesMTM: Core ElementsMedication Therapy Reviews Medication Therapy Reviews Polling question 2Minnesota Experience Slide Number 21Slide Number 22Slide Number 23Payers in Healthcare MedicareMACRA- MIPSMACRA- MIPSHypertension, Outcome: Systolic BPReferences: HTNDiabetes, Outcome: HbA1c�References - DiabetesDiabetes Self-Management TrainingMACRA MIPSEffect of Centralized Clinical Pharmacy Anticoagulation Service Effect of Centralized Clinical Pharmacy Anticoagulation Service Effect of Centralized Clinical Pharmacy Anticoagulation Service Medicare Part D Example of Cover LetterSlide Number 39Slide Number 40Fee-for-Service Billing OptionsPhysician Office PFS Incident-to billingIncident-to billingTransitional Care Non-Face-to-Face ServicesTransitional Care Chronic Care ManagementChronic Care ManagementChronic Care Management Chronic Care ManagementRole of Pharmacist in CCMComprehensive Primary Care Plus (CPC +)Timeline for integration of CMM Slide Number 55Slide Number 56Comprehensive Medication Management (CMM)Comprehensive Medication Management (CMM)Example of CPA Example of CPAExample CPAAppendix: MonitoringAppendix: Treatment GoalsAppendix: Initial TherapyExample of CPA Comprehensive Primary Care Plus (CPC +)References Slide Number 68