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UPlan Medication Therapy Management (MTM)
MTM Marketing Seminar – 3/15/2011
MTM Discussion Topics
UPlan Pharmacy Program UPlan decision to add MTM MTM program and structure MTM communications and target
marketing MTM Preliminary Information
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UPlan Pharmacy Program
UPlan Medical Program
1. Two Medical Administrators — Medica & HealthPartners / Five Plan Types
2. Carve Out Pharmacy Program — Prime Therapeutics (originally RxAmerica/CVS Caremark)
3. Wellness Program — through Healthways and StayWell
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UPlan Pharmacy Program Pharmacy Contract is completely pass through /
transparent Formulary Development
• Utilize PBM formulary with University input• Rely on College of Pharmacy Expertise
New Specialty Program effective 1/1/2011• High cost medications for complex conditions
• Fairview Specialty Pharmacy, Fairview hospital or clinic pharmacies
• SMDC or St. Luke’s in Duluth
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Pharmacy Program Statistics 39,000 Members 30,300 Members with Prescriptions 370,800 Prescriptions $33 Million Total Drug Cost Focus on Generic Medications
• 50.4% : January – December 2005• 74.2% : January – December 2010 • 75.1% : December 2010
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Pharmacy Benefit Design
Copay Structure
Generic Plus $8
Brand Formulary $25
Non-Formulary $50
Non-Covered Full Cost
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UPlan Decision to Add MTM
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Decision to Add MTM UPlan decisions:
• Made by administration committee — AWG• Reviewed with employee committee — BAC
UPlan focus on evidence-based medicine Outcomes & ROI
• Ashville, NC Results• 2008 U of M Study — Isetts, Schondelmeyer et al
• BCBS/Fairview MTM Patients Pilot Program: UMD, November 2007 to February
2009 • Helped determine structure & operation of new MTM
program All UPlan MTM program — March 2009 9
MTM Program & Structure
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MTM Eligibility
UPlan active employees, early retirees, dependents
Four or more UPlan covered medications• Not specific disease focused but most
patients have chronic conditions• 10,000 Eligible Members
Physician Referral
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$8 MTM Copay Reductions
Without MTM With MTM -
6 Months
Generic Plus $8 $0
Brand Formulary $25 $17
Non-Formulary $50 $34
Not Covered Full Cost Full Cost
Participating in MTM Participants select MTM pharmacist from
Directory and make appointment Participants sign Participation Agreement and
enroll through PBM Pharmacy visits are face-to-face
• Option for tele-med visits for out of area participants
Encourage three or more visits first year / two or more visits subsequent years
No cost to member for Pharmacy visits • Pharmacist claims paid by two medical plans using
MTM procedure codes
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UPlan MTM Network Developed internally with College of
Pharmacy • Same MTM network for both Medical
Plans 101 Pharmacists, 146 locations, 30
contracting entities• Includes pharmacists for U of M, major
local care systems, and local chain & independent pharmacies
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MTM Program Structure MTM Network Manager & Coordinator
• Credential and contract network pharmacists for the University
• Manage activities of Peer Advisory Committee• MTM pharmacist coaching• Peer Review process
MTM Executive Committee• College of Pharmacy and Employee Benefits • Responsible for:
• MTM program operations• Communications and target marketing, • Program evaluation
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MTM Communications & Target Marketing
MTM General Communications Written Communications
• Newsletters, brochures, letters• Emails
Employee Benefits website • www.umn.edu/ohr/benefits/pharmacy/mtm/• Network Directory, Enrollment Form, PowerPoint
Presentation Customer Service Communications
• Employee Benefits, Health Plans, PBM Pharmacy Network Communications
• Emails, newsletters, website• www.umn.edu/ohr/benefits/pharmacy/mtmproviders/
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MTM Target Marketing Target Marketing — Pilot Program
• University of MN — Duluth• Letters & brochures, plus 2 follow-up phone calls• Handled by RxAmerica as PBM
Target Marketing — UPlan-wide Program • Letters & brochures, plus 2 follow-up phone calls• Handled by each member’s medical plan• Better response through medical plan target
marketing Enrollment results
• 722 members (about half from target marketing)• 10,000 eligible / 7% overall participation• 56 of 722 still have incentives remaining
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MTM Preliminary Information
(data from Medica members only)
Comparative Predicted Risk Score
Members not in MTM Members in MTM
+340%
Source: Johns Hopkins Adjusted Clinical Group Analysis
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Chronic Disease Comorbidity
43%
24%
10%13%
24%22%
24%
16%
2%2%5%0%
0%
20%
40%
0 1 2 3 4 5+
Members not in MTM
Members in MTM
number of chronic conditions
Source: Johns Hopkins Adjusted Clinical Group Analysis
% o
f mem
bers
with
mul
tiple
chr
onic
co
nditi
ons
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Types of Visits
43%
57%
1st Visit
Follow Up
Source: Claims review Jan – Aug 2010
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MTM – from a Patient’s Perspective
Initially enrolled due to copay reductions True value — excellent advice from MTM
pharmacist Helped me understand how medications work
• Side-effects • Interaction with over-the-counter medications
Communicated regularly with my physician Helped me make important decisions about my
medications and my health care
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UPlan Medication Therapy Management (MTM)
MTM Marketing Seminar – 3/15/2011