Expertise and Entrepreneurship at the College of Pharmacy

“Everyone who called was truly interested in my health. It was very nice to talk to someone who was so dedicated to their profession, and the health of others.”

“I don’t have words to tell you how helpful your service was; I have a hard time understanding things, but the pharmacist who interviewed me helped me immensely because I am taking 29 tablets a day. I am very grateful to her.”

These are quotes from two Medicare recipients who called the medication therapy management center at the UF College of Pharmacy. Most of you have probably not heard about the concept of medication therapy management, or MTM. This is a mandated component of the Medicare Modernization Act of 2003. It was designed to ensure that Medicare beneficiaries, especially those on complex drug regimens, take their medications safely and effectively. To address this mandate, many companies have developed MTM programs, mostly in the private sector. Seven years ago, due to the prescient wisdom of David Angaran, a retired professor of pharmacy, the college entered the industry and established an MTM center that has now grown to 155 employees (100 FTEs).

This issue of OTSP is the story of how pharmaceutical expertise has fruitfully combined with entrepreneurship at the College of Pharmacy to create a growing clinical service and business that serves Medicare and Medicaid recipients, and also supports the college’s education and research missions.

As we have discussed in these pages many times, a powerful trait of an academic health center is its ability to create positive feedback loops among its missions. Typically, the “service” mission participates in this feedback loop through direct patient care. That is, the financial margins created by the clinical enterprise are invested back into research and education, which in turn attracts the best and brightest faculty and students, who then further expand the clinical enterprise. This process also occurs with MTM, but with a twist. Instead of the service mission being direct clinical services billed to patients, it consists of contracts with insurance companies to provide information and counseling to their members about the medications prescribed to them by their physicians and other providers.

The expansion of the Medicare program through the Medicare Modernization Act included an outpatient prescription drug benefit. This began an important new chapter in Medicare by covering prescription medications through a new benefit called “Medicare Part D.” It was recognized that this new drug benefit would increase the use of prescription drugs and therefore increase the potential for medication-related problems. Hence, an important protection written into the Act, which anticipated the potential harms of complex medication prescribing, was a new mandated service to provide medication therapy management. The major objectives of MTM were to optimize therapeutic outcomes through improved medication use and to reduce the risk of adverse events. Under the Medicare Modernization Act, insurance plans were directed to target beneficiaries who (1) have multiple chronic conditions, (2) are taking multiple medications, and (3) are likely to incur high drug expenses.

Thus, under the Act insurance plans were mandated to offer MTM programs to help Medicare beneficiaries use medications safely and effectively. That is where the College of Pharmacy stepped in. Medication therapy management is a unique niche for the pharmacy profession, allowing pharmacists to apply their extensive medication knowledge as medication experts with the intent of improving patient outcomes. By creating an MTM service within the college, such services could not only fulfill the objectives of the MMA to ensure that Medicare recipients take their prescribed medications in a manner that optimizes their health outcomes, but also would provide a venue for students to learn the practice of pharmacy and generate a financial margin that could be used to support research.

The UF Medication Therapy Management Care and Communication Center began in 2009 working as an extension of a Medicare Part D sponsor’s internal MTM team. Initially, the center was run by four College of Pharmacy faculty members. The original concept was that the college’s MTM center would also provide clinical rotations for 12 fourth-year student pharmacists at the college. This educational arm of the center continues to this day. In 2012, however, a new line of services was launched: the center opened its second branch at the UF Research and Academic center in Orlando to help Part D and Medicare Advantage Prescription Drug plans enhance their performance on the Medicare Star Ratings. This led to the hiring of additional pharmacists and pharmacy technicians to provide the needed MTM services.

Today the Medication Therapy Management Care and Communication Center is staffed primarily by clinical pharmacists and technicians with a large support team of pharmacy residents, clinical and research faculty, as well as a team of software developers, programmers and data analysts. The center is headed by Anna Hall, Pharm.D., an assistant professor of pharmacotherapy and translational research at the College of Pharmacy. She and her leadership team oversee business and strategic development, operations and clinical program development, quality performance and compliance, and information technology for the center’s MTM services.

Under the directorship of Dr. Hall, the center provides MTM and performance measure improvement services to support a number of Medicare Advantage and Part D plans, as well as Medicaid and Medicaid managed care programs. Spurring the development of the center, critical contributions were made by John Gums, Pharm.D., associate dean for clinical and administrative affairs at the College of Pharmacy, and a professor of pharmacy and medicine.

Since its inception the center’s revenue has grown from $1.5 million annually to $8.5 million. As noted above, in this process employees have grown to 155 employees. Pharmacy students continue to benefit from rotating through the center to learn about complex medication regimens for individuals with chronic illness. Financial margins from the center are being invested in a variety of research projects at the college. Moreover, there have been many publications based on data analysis from the Medication Therapy Management Care and Communication Center: http://mtmccc.pharmacy.ufl.edu/publicationsresearch/. Several additional manuscripts are currently under review, one of which is a large, successful randomized controlled trial regarding the benefits of engaging beneficiaries in MTM services.

In summary, when professional knowledge meets entrepreneurship, as it has with the College of Pharmacy with the Medication Therapy Management Care and Communication Center, the virtuous circle of research, education and service expands in size and stature. The future is indeed bright for the center as the center continues to form strategic partnerships, expands its services to additional health care organizations, and advances the education and research missions of the College of Pharmacy.

The Power of Together,

David S. Guzick, M.D., Ph.D. Senior Vice President for Health Affairs, UF President, UF Health