Explanation of Benefits

More Than A Spoonful Of Sugar

Medication therapy management makes the medicine go down—along with employer health costs.

More Than A Spoonful Of Sugar

Growing up when sitcoms, rather than reality TV, dominated the airwaves, the initials “MTM” meant only one thing: Mary Tyler Moore. As I creep into my mid-50s, I still watch Mary Tyler Moore Show reruns, but MTM has come to mean something different, as who knows how many chronic medical conditions I’ll be developing: medication therapy management.

MTM is a program or service provided by a pharmacy or pharmacist in consultation with your physician to oversee the prescription medications you’re taking. Like having a primary care doctor manage your basic aches and pains, you have a pharmacy or pharmacist manage your prescription drug use. That function is becoming increasingly important as more and more people—your employees—take more and more prescription drugs to treat short- or long-term medical conditions. A recent study by the Mayo Clinic found that more than 20 percent of the people it studied took five or more prescription drugs on a daily basis (bit.ly/1xBCmwf).

At a minimum, an MTM program offers an employee what’s called an annual comprehensive medication review, or CMR, that identifies all the medications being used, determines whether contraindications exist and drafts a medication treatment plan for the employee and his or her caregivers to follow. Most MTM programs, though, offer much more in terms of services to enrollees, from frequent and regular medication reviews to mobile technologies that monitor prescription drug use and medication adherence. America’s Health Insurance Plans, the national trade group representing health insurers, recently published a report that identifies many of the MTM innovations taking place in the market (bit.ly/1kCKh6T).


Numerous studies have found that as much as 50 percent of all prescribed drugs are not used properly, ranging from taking the wrong medication to taking the wrong dose to not filling the prescriptions. Using prescription drugs improperly adds an estimated $100 billion to $300 billion to the nation’s health care bill each year, with employers picking up a lot of that tab.

One of the largest studies to date on the effectiveness of MTM programs to reduce health care costs caused by the improper use of prescription medications was conducted in Minneapolis at Fairview Health Services, which launched its MTM program in 1998. Over the first 10 years of the program, it identified nearly 40,000 drug therapy problems; the two most common were the need for an additional drug and the wrong (low) dosage of the right drug. The study estimated that for every dollar spent on the MTM program, it saved $1.29 in additional healthcare costs (1.usa.gov/1vxszVr ).

Most health insurers have their own MTM programs, or MTM benefits for enrollees who want to use another service, most likely provided by their local health care system or pharmacy chain. Employers should make sure their carriers offer MTM programs or benefits for workers, and then work with their carriers to encourage employees to use the available MTM services to the fullest extent possible.

Not only will MTM help me stay alive longer so I can watch more episodes of the Mary Tyler Moore Show, it will allow employees to avoid repeat visits to the doctor and unnecessary admissions to the hospital that drive up health care costs and, consequently, their employers’ health insurance premiums.

Short take

Somebody knows something. When the ACA-established state insurance exchanges opened their second annual enrollment period starting in November, employees who were shunted over to the state exchanges by their employers had more health insurance carriers to choose from. According to figures released by the U.S. Department of Health and Human Services, the total number of carriers selling health plans through the 44 state exchanges for which it had data jumped 25 percent to 315 for calendar year 2015—up from 252 this year (1.usa.gov/1vd1uF9). Though 14 carriers dropped out of the state exchanges included in the report, 77 first-timers joined the fray, for a net gain of 63. At the time of the HHS report, Minnesota was one of seven states that had not yet reported its state insurance exchange tallies. Five carriers are expected to sell coverage through MNsure, the state’s insurance exchange, in 2015. That’s the same number as in 2014, although it’s a slightly different roster. As reported in Twin Cities Business, PreferredOne pulled out of the program for the year ahead (bit.ly/1sM8xaS). But Blue Plus, an affiliate of Blue Cross and Blue Shield of Minnesota, took its place. I’m not an underwriter or an actuary, but I do know enough about insurance to know that a carrier wouldn’t be participating in a state insurance exchange if it didn’t think it could turn a few bucks. And it’s not going to participate if it thinks it will lose money.


The September column discussed the economic conditions finally being right to ignite the long-predicted explosion in domestic and international medical tourism (bit.ly/1pd0n3a). The mix of price transparency, bundled medical services and consumer-driven health plans finally may prompt employers to send their employees packing to neighboring cities, states and even countries for better care at lower—and fixed and predictable—prices. Well, it turns out we’re not the only ones who think so. Fitch Ratings, the New York-based financial ratings agency, released a five-page report that concluded that direct contracting arrangements, or domestic medical tourism agreements, between employers and health care providers “…will gain in popularity and acceptance in the near to medium term” (bit.ly/1poTJId). And if you or your employees are feeling a bit more adventurous, the International Healthcare Research Center released the results of its latest Medical Tourism Index, which ranks 25 countries based on their attractiveness as a medical tourism destination. The top five countries, according to the index, are: Canada, the United Kingdom, Israel, Singapore and Costa Rica (bit.ly/1wVt1fB). The quality of the care must be great and the prices must be cheap because I doubt the hospital food will be any good.

David Burda (twitter.com/@davidrburda, dburda@msp-c.com) is editorial director, health care strategies, for MSP-C, where he serves as the chief health care content strategist and health care subject matter expert.


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