Operationalizing MTM through the use of health information technology.
BACKGROUND
Health information technology (HIT) tools are needed to sort the ever increasing volume of available clinical data, and thereby allow patients, practitioners, and health plans to understand and use the data to its fullest potential By harnessing this potential, managed care organizations (MCOs) will see improvements in the quality of health care and ultimately reduced costs. Furthermore, HIT offers the ability to help improve communication channels to share the increasing amounts of information available to MCOs today. In effect, medication therapy management (MTM) programs are using HIT to identify an at-risk population and reach that population in the most appropriate measure.


OBJECTIVE
To identify and review the design components of an operationally effective MTM program, including the services offered. The use of HIT in quality improvement initiatives at managed care plans will also be reviewed.


CONCLUSIONS
The operational components of MTM programs that rely heavily on HIT include patient identification, stratification of care, coordination of care, and safety evaluation. Primarily, HIT plays a significant role in identifying the services offered to MTM program patients in MCOs. For example, the Humana MTM program offers personalized educational mailings, telephone consultations, and face-to-face consultations with the community pharmacist. Within the plan, HIT is used to score and stratify eligible patients according to these available services. HIT is further employed to coordinate the collective efforts of pharmacists and physicians in the administration of care, as well as to monitor medication safety measures. Health plans gain a greater ability to improve the quality of care for their patients through proper application of HIT. The opportunities exist both internally at the plan and externally partnered with other organizations. Quality improvement begins with proper recording and tracking of quality measures and then the development of quality improvement projects in an effort to improve the process of care and the resulting health outcomes.


CONCLUSIONS
As the amount of data available to managed care stakeholders increases, HIT is becoming a crucial tool for sorting and stratifying the information. MTM programs provide another example of the application of HIT in managed care, with involvement on every level of the care continuum: payers, providers, and patients. Services offered by MTM programs are useful and varied, including process-improving initiatives, such as personalized educational mailings, telephone consultations, and face-to-face consultations with the community pharmacist. The end result is quality improvement in the delivery of care with a focus on improving medication adherence and safety.
McMahan
Robert
R
Fidelis Care, 95-25 Queens Blvd., Rego Park, NY 11374, USA. rmcmahan@fideliscare.org
D020811:Biomedical Technology / Q000379:methods*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration / Q000592:standards; D008490:Medical Informatics / Q000379:methods; D054539:Medication Therapy Management / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration*; D014481:United States