Medication Management Models for Chronic Disease Management

Medication management involves helping patients with chronic diseases manage use of prescription medications, with the goal of helping ease symptoms and disease progression. Medication adherence, or taking medications as prescribed, is important for managing and treating many chronic diseases.

Medication therapy management (MTM) is a patient-centered approach in which pharmacists help manage patient medications in a way that improves health outcomes and quality of life. MTM interventions can include focusing on improving patient adherence to medication plans based on their disease, assessing medication supplies, and reviewing current medications.

MTM commonly involves the following steps:

Medication therapy review
Personal medication record
Medication-related action plan
Intervention and/or referral to other healthcare professional(s)
Documentation and follow-up

MTM can be implemented in clinical and non-clinical settings. MTM can occur during in-person visits and via remote methods such as telephone, telehealth visits, or text message reminders. The Community Preventive Services Task Force recommends text messaging as a strategy to improve medication adherence among patients with chronic disease.

Comprehensive medication management (CMM) is a component of MTM where a patient's prescription medications are thoroughly reviewed for safety, interactions, and appropriateness for the patient's conditions. The patient has a tailored care plan based on this review which identifies follow-up opportunities and tracks outcomes. CMM can occur during in-person visits or virtually.

Examples of Rural Programs Using Medication Management for Chronic Diseases

Ohio Northern University's ONU HealthWise uses a mobile health clinic staffed by health professions students to deliver educational outreach and healthcare services, including MTM, in rural Hardin County, Ohio. The mobile clinic offers services several times each week at a variety of locations in the county, including churches, schools, and other gathering spaces. The program uses health professions students to address local barriers related to health professional shortages. Other services include smoking cessation education, medication reconciliation, and patient navigation assistance for people with chronic diseases.
The MTM Consortium in Ohio is a partnership between the Ohio Department of Health, Ohio Pharmacists Association, Ohio Association of Community Health Centers, the Health Services Advisory Group, and the Ohio Colleges of Pharmacy. The Consortium delivers MTM services to people with chronic diseases across Ohio, with a focus on expanding access to MTM to patients in Federally Qualified Health Centers with diabetes and high blood pressure. Pharmacists who participate in the MTM Consortium focus on resolving medication-related problems, managing patient illness, and improving health outcomes.
The Wisconsin Department of Health, the Pharmacy Society of Wisconsin, and NeuGen partnered to administer a pharmacist-led MTM pilot program for patients with high blood pressure in Wisconsin, including participants living in several rural counties. Program participants showed better management of their blood pressure and improved medication adherence. The program demonstrated the benefits of pharmacists managing medications and helping patients navigate chronic disease. Program participants showed better management of their blood pressure and improved medication adherence.
HomeMeds is an evidence-based program that can be used for medication management for people with chronic diseases. This program is being used and adapted for implementation in rural organizations like the Lake County Tribal Health Consortium. The program can be administered during home visits by community health workers or other care coordinators. Program staff perform medication screenings to ensure medication adherence for people with chronic diseases and monitoring to ensure there are no medication errors or dangerous interactions occurring. If issues are identified during this screening, trained pharmacists or nurse practitioners review and help address these concerns.
Well-Ahead Louisiana and the Louisiana Department of Health have compiled resources to help clinical and community settings across the state implement MTM using pharmacists to improve medication management for people with diabetes and heart disease. They provide organizations with support to offer MTM services to patients, including guidance on establishing a program, an online training series that reviews the basics of MTM, and information about Collaborative Drug Therapy Management (CDTM) between pharmacists and physicians to improve patient outcomes.
Health Coaches for Hypertension Control (HCHC) is an evidence-based program that originally began in rural Appalachia in western South Carolina but is now being implemented in several other rural locations. HCHC is a training program for older adult patients living with hypertension to help them manage their blood pressure through medication management, proper nutrition, and physical activity. Volunteer community members are trained as health coaches to lead training sessions. An evaluation of the program has demonstrated improved outcomes for participants, including blood pressure, weight, glucose levels, and knowledge about hypertension.

Implementation Considerations

While pharmacists are often the main healthcare professional involved in MTM, they are not considered healthcare providers in all states in the U.S. This can impact reimbursement by insurance companies and the Centers for Medicare & Medicaid Services (CMS), and in turn affect program staffing. In recent years, several states have introduced legislation to consider pharmacists healthcare providers. Programs may need to rely on different forms of funding if community pharmacists are not eligible for reimbursement for providing MTM services. As of 2019, 25 states had laws in place about pharmacists leading MTM services, some of these related to Medicaid reimbursements for MTM services.

MTM programs like HomeMeds that are delivered in the home can be administered by health coaches, social workers, community health workers, pharmacists, or other individuals specifically trained to complete these types of assessments in the home. Each program and each community will determine the best staff to fit this role. One challenge with some of these programs involves language accessibility. For example, HomeMeds is not currently offered in languages other than English, which limits the rural populations that can benefit from these services.

In addition to the high costs associated with medications used to treat chronic diseases, many conditions may also require use of medical devices. There may be issues with medication adherence if patients (and sometimes healthcare providers) do not understand how these types of devices should function. Healthcare providers may consider a teach-back method as an effective way to ensure patients understand instructions on how to use medical devices.

Program Clearinghouse Examples

Resources to Learn More

Improving Chronic Disease Outcomes Through Medication Therapy Management in Federally Qualified Health Centers
Document
Reports on a study showing improvements in patient outcomes after receiving medication therapy management (MTM) services in three Federally Qualified Health Centers by MTM-trained pharmacists for treatment of diabetes and hypertension.
Author(s): Rodis, J.L., Sevin, A., Awad, M.H., et al.
Citation: Journal of Primary Care & Community Health, 8(4), 324-331
Date: 2017

Medication Therapy Management Pharmacist Reference Book
Document
Provides an overview of medication therapy management (MTM) for pharmacists. Covers clinical guidance, legal definitions and implementation requirements by state, MTM models, training resources, and Medicaid reimbursement by state.
Organization(s): National Board of Medication Therapy Management
Date: 9/2020