CMM, by design, generates value. Medication management services are being given increasing attention given the critical role medication plans play in treating acute and chronic conditions. There are two major approaches to medication management, Comprehensive Medication Management (CMM) and Medication Therapy Management (MTM). The strategically significant difference between the two is the difference between being accountable for results and responsible for transactions. Accountability for results is a path to value and financing, responsibility for transactions is another cost and constraint.
AIMM recognizes that Comprehensive Medication Management (CMM) is a unique and powerful service. What distinguishes it and makes it powerful is the fact that it is designed to produce results rather than generate activity. MTM payment in Medicare Part D is rendered for the act of intervening on a potential medication problem. There is no consideration as to whether the problem is resolved. Follow up with patients to confirm a result is rare. In CMM, the practice model explicitly defines follow up and confirmation of resolution of a problem as a core component of the service. This situation creates opportunities for scale up and finance. That work has started.
AIMM participated in the CMM in Primary Care Research Team [The American College of Clinical Pharmacy (ACCP), the American College of Clinical Pharmacy Research Institute, the UNC Eshelman Institute for Innovation, & University of Minnesota College of Pharmacy] that reviewed research findings to operationally define CMM as a core strategy for serving patients with multiple chronic conditions. The intent was to ensure that CMM as a strategy is well defined, can be replicated with consistency and fidelity across care settings, yields positive outcomes and impact on patient care, and is supported by a business case for scaling and sustaining the service. To access the July, 2018 report click here.
CMM has evolved as a service that produces value. It is well enough defined to produce predictable results at an affordable (attractive) cost for well-defined, high-risk patient groups.
The next stages of development require a new kind of collaborative. Over the past ten years AIMM has helped health care organizations to integrate the service of CMM, into their care delivery systems. AIMM-facilitated learning collaboratives follow a systematic and methodical approach using quality improvement techniques and implementation science principles. In this work AIMM emphasizes that the accountability of the clinical pharmacist is to obtain results — patient-related outcomes and reduction in avoidable service utilization and cost.
This September AIMM will conclude its A3 Collaborative, a learning collaborative experience designed to support provider organizations in putting CMM operations in place. We have learned a great deal from the more than 100 participating health care organizations, over five 12-month collaborative cycles. Participating teams have demonstrated the critical elements to create effective CMM delivery systems on the ground. The next stages of development are two fold: to bring these models to full scale defined by population management and risk assessment and to establish the financing programs that make CMM part of the necessary integrated service delivery systems.
Going forward, AIMM is redesigning its collaborative experience to address these technical and policy challenges. We envision collaboratives working with coalitions of providers and payers. This gives a higher level of integration and scale than the organization team-based collaborative experience. We are approaching community based coalitions and organizations wishing to form local coalitions. Let us know if you are interested. We look forward to continuing to share what we are designing and how we are working with partners. We are inviting more to join us! Stay in touch with AIMM; email info@aimmweb.org to request to join our communication listserv.
Associate Executive Director, AIMM & Lead Program Development Coach