Most employers want to find a health plan that will improve employee health affordably. But in their selection process, many overlook key players who influence patient outcomes and costs: the clinical pharmacists.

Studies show that 50% of medications prescribed are not taken as directed for various reasons. Whether it's cost, side effects, not seeing a benefit or burnout from having too many pills to take – many barriers exist that prevent patients from successfully taking their meds.

Lisa Sheldon, Medication Therapy Management Pharmacist for HealthPartners Park Nicollet Health Services, understands these barriers and has made it her mission to eliminate them. She teaches patients how to give their meds the best chance to work.

"I meet directly with patients and review their medications systematically to make sure they are all necessary, cost effective, and working for them without any side effects or risk of interactions. Then, I help them manage their medication routine to fit their life situation so they can take their meds consistently and effectively," she explains.

As part of the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, medication therapy management (MTM) is offered to those with Medicare Part D prescription drug plans. Since the beginning, HealthPartners has led the way in implementing a variety of MTM services.

MTM services are an integral part of the health plan options available at HealthPartners. They’re offered at no cost to participating members because they measurably improve patient health and reduce health care costs. Analyses show they can save $1268 per engaged member annually.

"If patients understand what their medication is doing and why they're taking it, they're much more likely to participate," Sheldon says. "One of my patients was so excited about his blood sugar lab results after I changed his diabetes medication, that he made sure to notify me about them in our electronic message system."

The MTM process

The foundation of MTM involves the in-depth review of a patient's prescriptions, over-the-counter medicines, and supplements like vitamins or herbal medications. “It can be eye-opening,” says Sheldon.

"I've had patients bring pillboxes, tackle boxes and rolling suitcase backpacks to their first session," Sheldon tells us. “They bring in all their meds from various doctors and we look at them comprehensively.”

According to the Centers for Disease Control and Prevention (CDC), the fundamentals of MTM include five core elements:

• Medication therapy review (including assessment of any medication-related problems)
• An updated personal medication record
• Development of a medication-related action plan intervention or referral
• Documentation
• Follow-up

MTM gives patients a chance to review all their medications in one place together, often for the first time, too. They find out if they’re all really necessary, if they’re the most cost-effective options and if they’re working together correctly without side effects.

"As a pharmacist, spending time with a patient to uncover how medications might be causing some issues, or how other meds could improve them," Sheldon shares, "and then seeing their progress – it's so rewarding."

Pharmacy interventions can save lives

During a patient visit, MTM pharmacists may recommend medication doses adjustments, lab tests or other changes to improve medication outcomes.

"Medications can be a puzzle," Sheldon says. "Different meds do different things and don't always produce the desired results for each patient."

A real-world example of clinical intervention and its impact

Sheldon has one or two interventions per visit with new and follow-up patients in her MTM practice. She sees them as an impactful, proactive way to reduce overall health-care costs, improve patient outcomes and, ultimately, save lives.

"I recently met with a patient who experienced many side effects from their cholesterol medicine. The cardiologist tried adjusting the dose, but that didn't work. They needed to be on something to reduce cholesterol because they'd had a heart attack and didn't want to have another one. So, we switched to a new med that was less likely to cause the same negative effects."

Patients who have chronic conditions, experience frequent hospitalizations or have multiple medications are referred to Sheldon by their doctors. Having an MTM specialist on the team makes it easier for physicians to focus on their primary goal of diagnosing and treating patients versus managing their medications.

"Doctors are under pressure to do so much in a short amount of time," Lisa explains. “They‘ve told me that because I've done my job, it’s easier for them to do their jobs because they know their patient's medication list is accurate."

The role of pharmacy informatics in MTM

As defined by the American Society of Health-System Pharmacists, pharmacy informatics is the integration and use of knowledge, information, technology, data and automation in the medication-use process. Informatics help MTM pharmacists improve treatment plans for patients as well as be more efficient when prescribing and administering medications.

For example, Sheldon can drill down and look for patients who are not meeting their goals or are more likely to have challenges with their meds.

She can also track quality measures like the number of patients she’s seen, the types of conditions addressed and the number of problems she’s identified and solved.

"Medications are a huge cause of health care expenses. We know that there's a tremendous opportunity to use informatics data to improve patient outcomes and prevent additional health costs by using MTM pharmacist services."

Who benefits from MTM?

Patients with multiple chronic conditions, high prescription drug costs, or complex or high-risk medication therapies, or who are cared for by several clinical specialists, benefit the most from MTM services.

Algorithms can alert health plans about people like these who may have potential challenges with their therapies or are not meeting their goals. A coordinated communication plan then swings into action to guide them to MTM services that help prevent problems from developing or getting worse.

“Any study I’ve looked at shows a positive return on investment from including MTM pharmacists in health-care services,” Sheldon explains. "Whether that's a reduction in hospitalizations, emergency room visits or overall health-care costs, MTM shows a positive financial return by lowering health care expenses annually."

The detailed detective work of an MTM review

Sheldon had a recent example of how MTM can make a meaningful impact after a one-on-one medication review. A patient was having difficulty reaching her goals with her diabetes medication.

"We couldn't figure out why she had so many low blood-sugar readings overnight, but then rebounded high during the day. Then we realized it was all about timing: She had been taking her insulin at bedtime instead of before lunch. Her issues had nothing to do with the dose but everything to do with when she was taking it for it to work well."

Successful clinical pharmacist intervention is about relationships

Pharmacists – whether MTM specialists or not – are often the most frequent touchpoints in a person’s health journey. They play a vital role not just as clinical pharmacy experts but also as partners whom their patients and medical colleagues trust.

“What I love about my job," Sheldon says, "are the relationships. The relationships with the patients, physicians and nurses I work with. I just love that sense of team that we have – I think it's very powerful. I'm grateful for the chance to do this work."

Learn more about HealthPartners medication therapy management services.