Findings from University of Minnesota Update Knowledge of Managed Care and Specialty Pharmacy (Building Health Plan-pharmacist Provider Partnerships To Optimize Medication Outcomes): Drugs and Therapies – Managed Care and Specialty Pharmacy

2024 APR 03 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Investigators discuss new findings in Drugs and Therapies - Managed Care and Specialty Pharmacy. According to news originating from Minneapolis, Minnesota, by NewsRx correspondents, research stated, “Over the years, the practice of medication management has taken on various terms and definitions. As a result, health plans have developed different approaches to identifying beneficiaries for medication therapy management (MTM), engaging pharmacists to provide MTM, and adopting standards for documentation and quality assurance.”

Funders for this research include Minnesota Department of Health, Centers for Disease Control & Prevention - USA.

Our news journalists obtained a quote from the research from the University of Minnesota, “This variation leads to inconsistent delivery of MTM and potential quality concerns. Therefore, an environment needs to be created that allows for health plans to discuss and share approaches, challenges, and best practices. To achieve this, the University of Minnesota College of Pharmacy has served as an organizer and facilitator of an ongoing series of Minnesota Health Plan Summits to drive sustainable and mutually beneficial MTM programs and payment models across the state. In less than 2 years, the University of Minnesota College of Pharmacy has hosted and organized 4 Health Plan Summits with the objective of sharing ideas and identifying mutual goals (short- and long-term) across health plans and pharmacy providers of MTM services to optimize medication outcomes for the citizens of Minnesota and beyond. These meetings have led to several productive discussions and takeaways, including: (1) having a convener is essential for these types of connections and discussions, (2) health plans and pharmacists find value in these summits, (3) there is a range of experience in MTM program development across health plans, and (4) there are important opportunities to enhance understanding between health plans and pharmacist providers. In addition, 3 workgroups have been established in the following areas: (1) improve consistency in the design of MTM benefits across health plans for service and delivery, including provider credentialing, (2) increase transparency and education between plans and providers on the ‘fixed points’ (such as CMS requirements) vs modifiable portions of plan design, and (3) create agreement on a single quality metric to target, collect data, and demonstrate value of MTM. For change to occur, it often must start locally, suggesting that the formal, facilitated convening of local health plan leaders and pharmacist providers to discuss building consistent and high-quality MTM programs is an essential strategy for MTM program adoption and growth. Including both groups of stakeholders should not only focus on payment, but also the mechanisms necessary to support implementation and create a win-win for both groups. In sharing our experience in Minnesota, we aim to inspire others to form regional initiatives that create structured, facilitated conversations that can produce new partnerships.”

According to the news editors, the research concluded: “Strategies that have supported our success are described and can be adopted once a regional entity, such as a school of pharmacy or other trusted entity, chooses to convene a group of invested stakeholders.”

This research has been peer-reviewed.

For more information on this research see: Building Health Plan-pharmacist Provider Partnerships To Optimize Medication Outcomes. Journal of Managed Care & Specialty Pharmacy, 2023;29(12):1284-1289. Journal of Managed Care & Specialty Pharmacy can be contacted at: Acad Managed Care Pharmacy, 100 N Pitt St, 400, Alexandria, VA 22314-3134, USA.

The news correspondents report that additional information may be obtained from Deborah L. Pestka, University of Minnesota, Minneapolis, MN 55455, United States. Additional authors for this research include Todd D. Sorensen and Sarah M. Westberg.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.18553/jmcp.2023.29.12.1284. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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