Pharmacists Can Develop Their Own Business Models for Patient Care

Medication Therapy Management (MTM) programs offer pharmacists expanded opportunities to use their clinical skill set as drug information experts to provide patient care services, but there are challenges to integrating MTM services into the community pharmacy practice setting.¹

Medicare Part D MTM delivery has increased to approximately 65% of plans using community pharmacists through MTM vendor contracts.¹ However, many prescription drug plans are not using pharmacists as the primary providers for Part D MTM services. Pharmacists are in a unique position to develop their own business plans to create innovative face-to-face and virtual MTM practices.

Developing a Practice

Incorporating MTM services into a community practice setting may not be feasible because of a lack of pharmacy staff members, limited training opportunities, and obstacles integrating shared electronic health record systems.¹ Aligning MTM with value-based care delivery through the development of payment models that reward positive outcomes is critical for building a sustainable business model.¹ When developing an MTM business plan, determining the location where services will be offered is crucial.² Possibilities include a home office with virtual services, offering consults on site at employers’ locations, or renting space at a physician’s practice.² Additionally, other pharmacies in the region could contract with MTM pharmacists to provide services for patients enrolled in their Medicare Part D programs.²

Pharmacists should ensure that they become familiar with the terms of the agreement and carefully review all contracts.² Further, they should ensure that a lawyer reviews all the contract information before they sign any documents.² It is important to determine the costs associated with initiating and providing services including accountant fees; computer, including billing, documentation, and technology support; home office expenses; legal fees; liability insurance; marketing costs; mortgage or rent for office space; office supplies; patient supplies; postage; support staff; and travel expenses.²

On January 1, 2017, the Centers for Medicare & Medicaid Services launched a pilot program to evaluate changes to the traditional MTM model.^3,4 Enhanced MTM includes program changes, such as increased payment incentives and regulatory flexible patient enrollment requirements, which provide pharmacists with additional opportunities.³ Stand-alone basic prescription drug plans in selected regions can offer innovative MTM programs, with the ultimate goal of improving the quality of patient care while reducing costs.⁴ The following Part D sponsors are participating in the enhanced MTM model: Blue Cross Blue Shield Northern Plains Alliance, Blue Cross and Blue Shield of Florida, CVS Health (SilverScript Insurance Company/CVS Insurance Company), Humana, UnitedHealthcare (UnitedHealth Group), and Wellcare Prescription Insurance.^3,4

The first evaluation during the initial 20 months of the enhanced MTM program showed that there was an expanded pool of eligible beneficiaries who could receive tailored services.⁴ Predictive analytics was used to identify patients at high risk of experiencing drug-related problems, high spending, and hospital admissions.^3,4 Based on these parameters, patients were risk stratified to determine which services they should be offered. These expanded targeted criteria allow for more patients to qualify for services versus the traditional MTM parameters of drug spending, number of chronic conditions, and quantity of medications.⁴ Services provided include comprehensive and targeted medication reviews, medication reconciliation, and patient education.⁴ The enhanced MTM model provides more opportunities for innovative data-sharing systems, new partnerships, and novel programs for data reporting.⁴

Closer Look

In an interview, Jamie Wilkey, PharmD, founder of PGx Consulting Confidence Academy, discussed her pharmacogenomics consulting practice.⁵ She is a functional wellness pharmacist who is certified in pharmacogenomics and provides patient care using precision medicine.

“One test will change [the whole of] medicine,” Wilkey said, when discussing the important role that pharmacogenomics plays in MTM services.

As the CEO and founder of Arches Health, she manages patients individually in her clinical practice, both in person and virtually, and educates leaders in various clinical settings about strategies (see Figure) to integrate pharmacogenomics testing into their programs.²

“Believe your knowledge can help others,” Wilkey said, who provides this motivating tip to others starting their own businesses. She noted that having a business degree is not a requirement for developing a consulting practice.

Through the PGx Consulting Confidence Academy program, she educates pharmacists and other health care professionals about strategies to start their own consulting practices. The course is a 1-year self-paced program in which Wilkey walks pharmacists through a step-by-step process of starting a pharmacogenomics consulting practice. The company also includes a social network of like-minded health care professionals discussing the latest developments in MTM pharmacogenomics.

Jennifer Gershman, PharmD, CPh, is a drug information pharmacist and Pharmacy Times® contributor who resides in South Florida.

Reference

1. Ferreri SP, Hughes TD, Snyder ME. Medication therapy management: current challenges. Integr Pharm Res Pract. 2020;9:71-81. doi:10.2147/IPRP.S179628

2. Independent MTM pharmacist: mediation therapy management services. American Pharmacists Association. Accessed August 30, 2021. https://aphanet.pharmacist.com/sites/default/files/files/mtm_developing_a_indie_practice.pdf

3. PartDenhancedmedicationtherapymanagementmodel.CMS. gov. Updated August 3, 2021. Accessed August 30, 2021. https:// innovation.cms.gov/innovation-models/enhancedmtm

4. What is enhanced MTM? The National Board of Medication Therapy Management. Accessed August 30, 2021. https:// www.nbmtm.org/mtm-reference/what-is-enhanced-mtm/

5. Arches Health. Accessed August 30, 2021. https://www. archeshealthgroup.com/