Whether it’s a postgraduate receiving their license to practice as a New Practitioner or a pharmacy resident finally transitioning into their career, this time of year is a pivotal moment for transitions in pharmacy. While it would be nice to think that these were the only transitions occurring, the reality is that the health care environment in which we practice is transitioning as well. Although concepts such as “star ratings” and “pay for performance” have been resonating across the profession for a while, you may have recently started hearing a lot more hype about them, especially for medication therapy management (MTM). As many new pharmacists transition into practice, they are also transitioning into a new and exciting frontier that pharmacy has yet to see.

About 6 years ago, CMS created the star rating system, which measures health care plans on performance based on customer experience and patient outcomes. Since five of these measures can be improved by pharmacists, third party payers are now pushing for pharmacies to perform against the measures to improve health care plans’ star rating. The current measures affecting Medicare Part D plans (Medicare Advantage with Part D and Part D alone) weigh as much as three-fold when compared against the other measures that a plan must perform on to improve their star rating. These measures include the reduction of high-risk medications in the elderly; evidence-based treatment for hypertensive patients with diabetes; and adherence to renin angiotensin system antagonists, statins, and all non-insulin medications for patients with diabetes. While it is necessary to help the payer improve their star rating to stay in a preferred network, this is a chance for pharmacists to make more of an impact on their patients’ lives than with the standard counseling most of us perform today.

Medication therapy management has been a phrase used for quite some time and insurance plans are now seeing the benefit MTM services can have on their star ratings as well. As pharmacists, we can take the care for our patients to a whole new level by spending time with patients and building strong patient relationships with programs such as MTM. Not only does this build loyalty and trust with the patient, but relationships can be developed with prescribers as well. As we move to a “one-team” approach to health care, services such as MTM can help ease the transition of integrating the pharmacist into the health care team.

Currently, MTM is incentivized through third party payments based on documentation of interactions made by the provider. Although this is a benefit to the payer and their star rating, the reflection of actually improving the patients’ outcomes is not accurately displayed. With “pay for performance” replacing “fee for service” in many insurance plans’ contracts, there will be more of a focus on what care the patient actually received (the performance) versus the documentation made (the service). As pharmacists, this is the perfect opportunity to show our capability of being health care providers in this rapidly growing environment of patient centered care.

So, are you ready? Are you ready to initiate this journey of being the most valued, most trusted, and most easily accessible health care provider in the industry? Whether you are a seasoned pharmacist or a fresh New Practitioner, providing MTM services is only the beginning of where we can make our mark as pharmacists in the health care system.

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