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Has anyone started this new field MTM Outcomes??
MTM Outcomes
- Thread starter nextyearrx
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There is no new field. Outcomes MTM is an intermediary between the PBMs and pharmacy (not the pharmacist). They are a software vendor that makes money puppeetering the pharmacist employee to do interventions for peanuts.
There is a linkedin group that holds the details and discussion that might interest you. Search groups for MTM and pharmacist and you will find it.
There is a linkedin group that holds the details and discussion that might interest you. Search groups for MTM and pharmacist and you will find it.
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Outcomes can be a good jumping off point for a goal of self employed pharmacist mtm practice. Since your average billables can hit $100-300/hr if you bill correctly, it is a reasonable place to start, however your milage is going to be limited at first, especially if you haven't trained in the system.
I've done about 500 hours of outcomes mtm, I think I probably averaged around $60/hr of paid claims toward the end... but it's not easy. At first though it was hard to even break $20/hr. I have had some claims denied, but even one or two successful patient encounters per hour will get you into the green, especially diabetes and asthma, billing as 'prevented medical emergency' for some pretty mild interventions.
On the other hand .. I know a couple of pharmacists with indie contracts with outcomes and other similar companies who are 'making it' as an independent contractor , pulling in > 100k per year after overhead.. so it is doable.
Depends on what kind of person you are. If you are entrepreneurial and have good sales / sweet talking skills you can go much farther. The job is eerily similar to cold call telemarketing .. which, ymmv.
If you try outcomes (it should be easy to give it a try at almost any practice site).. just remember, ask the pt about every med and every disease state during every call .. it is feast or famine.. my best billables came from pts who had no apparent problem at first, but by the end of the call you can rack up 3-5 claims after you discover their inappropriate otc use, untreated indications, or failure to adhere. .. even if only half are paid, that's still at least $1-3/minute of phone work if you are efficient with documentation and claim submission
90+% of calls are going to result in "sorry not interested" .. so be prepared for that... your other calls will make up for it.
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Another thing to know is that you need a pretty big patient base to make it a full time job. At least several thousand to pull from... which , if you are hanging your own shingle .. you'll need to get an arrangement first for a referral database either from outcomes or insurers. . This isn't insanely hard to get but you may be expected to start slow.. chains only get assigned more patients (stores) after they bill some good claims first.
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Several thousand is my understanding as well. With Outcomes the fact that you have to be affiliated with a pharmacy means you are a mule to the pharmacy operations first. It is not a matter of logging on to the Outcomes platform from home to tap into the never ending pile of cases. Which it should be.
Another key problem is what is reimbursable and how often. If one has that kind of access and time I hear it makes money but there isn't enough (legit cases) to go around.
I acknowledge the stated model of the entrepreneur. Sign up for Mirixa and see how many cases get sent your way. Perhaps there is a gold mine outside my geographic location.
Conceivably this is a concrete field, but with above average contingencies. Like you said, you have to pound the pavement and cold call with no guarantee of income. Without objective data i.e. labs, EMR access, my abilities are undermined and as such I have nothing I want to sell. That is me. I by no means intend to discourage a fellow with the joie de vivre for the mission. In fact it behooves me to support them.
I would like to know what percentage of claims involve non-compliance or adherence. After all on a long enough timeline most people are neither compliant or adherent. There is a incentive to target these medication reviews for billing opportunities instead of medical outcome. Is it ok for an intern to do these consults and a pharmacist sign off after reviewing it? Any issue with "do not call" states and calling patients who live there for CMRs?
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My perspective: each entity has it's own business model. Outcomes serves the PBM for big bucks and passes peanuts to the big box (from piece of pie perspective the indies are barely worth a mention 🙁). Mirixa is in bed with the schools some how and their motives are unknown. There is a spin off of Outcomes trying to forge it's own model. The original intention was professional fortitude but last I heard it seemed they were moving toward the software sales sides for the ROI. Ultimately what happens is the pharmacist(s) involved in the project gives up the rights to save their hide and further undermines the entire profession. I have observed this with other pharmacist initiated business models i.e. academic detailing.
Point is the information you are after, percentage of claims, is proprietary. I am sure there are published extracts available though. As you stated the incentive remains with the shortsighted outcomes in the interest of the PBMs bottom line. What they are really after is formulary switches. Prostitution IMO.
The more technical aspects like "do not call" I never bothered investigating. The intern laws are state specific and company policy often dictates more than the pharmacist overseeing. I have read studies that used interns for MTM but the reported details preclude reproduction. Again these models are specific to jurisdiction.
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I would say 80+% are adherence calls.
Yes it is fine to do it as an intern legally speaking (in states where interns have broad responsibilities) you can do all of the clinical things and administrative tasks as long as it is signed off afterward. Even technicians can do a large amount if they are in the picture..
Do not call can typically be ignored since you are not marketing a product or service per se, you are providing a service which the patient paid for in their insurance premium .. of course ethically it is a gray area as we can see from the answer to your other question: incentive
There's 2 main beneficiaries of mtm within a chain setting (not including the actual billable claims)
From insurer's perspective .. every call and cmr is about cost avoidance. The more cost you avoid, the better the claim and payment. Highest level is preventing death, followed by preventing er visit, followed by preventing doctor visit, disease exacerbation, etc alll the way down to even preventing a physician to have to be consulted for a new script.
From the pharmacy perspective .. the incentive is increased sales (adherence, new therapy) .. followed by reputation/marketing benefit (the appearance of being accessible, "caring" experts) which hopefully would drive further volume.
The interesting part is, for a big chain, I think on average they are benefiting more from the increased volume than the insurer is getting, let alone the actual billable claims .. in a given hour where I billed, say, $100 in adherence, pharmacy probably gained $500-$1000+ in gross sales. And the insurer got what. . Conceivably a couple hundred in net cost avoidance? So the incentives are clearly a little wacky at the moment.
Dont get me wrong, its a great thing for everyone.. but at this point the actual billable claims are, like stellargal indicates, peanuts and scraps from the cost avoidance and pharmacy revenue pie. Which kind of decreases the long term viability of doing this from your house on an independent basis. If you are great at telemarketing, you can make enough to survive on but you won't make it big. If you are with an independent dispensing pharmacy and you're doing it right, you will always be adding to the bottom line regardless of recovered $ in claims. If you work for a chain, you are basically going to end up making them a bunch of money from sometimes medically unnecessary fills ...
So It is a mixed bag. Personally I see it as the way of the future, but likely (hopefully) with more streamlining of incentives and better delineation between adherence and CMR and therapy calls. You can do CMR and therapy reviews from a home office at the moment, but revenue wise these are peanuts compared to hundreds of potential adherence claims with corresponding fills.
Edit: PS .. adherence was recently estimated to be a $100billion/year cost for the US market due to poor outcomes. There is a lot of room for money to be made by everyone involved in fixing this.. It's just starting to get off the ground.
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Very well rounded Type B. It is a kin to the mid-evil drawn and quartered method of torture. Sometimes you get a leg and a torso sometimes just a toe.
But you gotta play to win.- Joined
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Very well rounded Type B. It is a kin to the mid-evil drawn and quartered method of torture. Sometimes you get a leg and a torso sometimes just a toe.
The chain I work for has a very sporadic and mishmash implementation of mtm.. there are pharmacists doing it full time some districts, and some districts with literally no mtm activity and tens of thousands of potential claims untapped. You do have to play to win. Putting MTM into the dispensing workflow is a good place to start. I am hoping to convince DM to let me and a buddy implement it and boost all our fill #s (after software upgrade is complete). A technician can do a basic 1 minute adherence call if a pharmacist is a few feet away to deal with potential situations.
I know of 3 pharmacy chains that have software functionality to provide notifications for mtm claims. Ours is working on syncing our dispense notification queue with outcomes untapped claims (right now you have to check the website still even though you get an MTM eligible note during dispensing) .. when that happens, I think we will see people (rxm, dm, enterprising rphs) jumping all over doing calls routinely as part of dispensing. .. if you are interested in mtm and work at a chain, you are poised to be that person.
Of course I may be on the wrong side and it will move toward having FT mtm-only staff everywhere.. I wouldn't want to be that person tbh.. either way the company and the profession benefit though.
Its not going to revolutionize the role of the pharmacist... but it is going to be a big piece of the next level of pharmacy operations dovetailing into healthcare cost avoidance / outcomes improvement
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Nice. I have never heard about it from
a.) someone inside the chain and b.) w/ an actual interest in moving pharmacy forward. I think you an official expert and your inside perspective is priceless. I would not have guessed that 80% were adherence related. Updates would be great.
This is my point from a retail perspective...how much value is (a tech??) telling someone who admitted to missing a dose in the last week or two of being adherent? I would say none but will give in to marginal at best. And it's maybe 80% of claims? I would agree with this number having seen some of the high performer claims. They target common drugs and tailor their consult to find these easy claims. My point is be careful how these MTM claims are done and how much these patients are being called. It may do more damage to the profession than good in the long run.
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Nice. I have never heard about it from
Well I did 2 mtm rotations, one of which involved integrating outcomes into the dispensing process for a specialty (wags) pharmacy .. that worked out fine because they were overstaffed and only filled 70/day .. now I am about to start as a float for a different chain whom I have done mtm for in the past .. these pharmacies are much higher volume (200-400/day) .. but the company is much more on top of things software side , which WAGs wasn't a couple years ago.. so I'm keeping my fingers crossed. If we can do it before bigwigs get their hands in the pie, I think it will satisfy everyone.
I will update if you'd like. 🙂
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You are right.. oftentimes adherence calls (and most any calls) require some delicate finesse and sales skills .. and you are also right that the image of a pharmacist as an annoying telemarketer is also bad.. but I would also say less than 1/100 patients had a serious bad reaction to my calls .. you have to sell the fact that you're providing basically free medical care to them (prepaid through their premiums) .. once they understand that..most people (especially retired and have time on their hands) are eager to talk and get their "free" pharmacist consult/advice.
With adherence, you would be surprised to find how many patients have missed weeks or even months of important therapy. Oftentimes its just a matter of getting it refilled, put on auto fill, offering delivery, etc and bam, you often pick up a bunch of other prn fills due to the fact that you jogged their memory.
Getting paid claims requires some practice to refine your interviewing style .. but picking up fills on adherence is easy as dirt. If you don't have a game plan or an efficient prescriber communication workflow set up, you will bog down in the category of untreated indication, non guideline tx, or change in therapy claims.. but if you go in with those things ready , adding the new therapy claims just becomes routine with each call .. I will give a hint ... most common is missing ace/arb in diabetics, next up are post chf meds, followed by missing rescue/long acting inhalers.
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I get it, Big Box uses this to leverage their refill reminder gig. I think Plan B's second theory (FTE MTM dept) would better serve us but his efforts on the dispensing end can still set the ball rolling.
The tech calling IMO:
1. is ghetto
2. is also likely to end up setting a precedent with the law
3. bastardizes the profession
The public largely has no idea what a pharmacist even does and at this rate they never will. Connections, not claims, are going to get the profession moving forward. I understand why the tech is calling, but it is a sellout move and is so freakin short sighted. I understand we have to keep the money coming to keep the employer out of our hair but this can be achieved without selling the farm.
The way I see it, we are not in the business, we are the business. Yet we have no voice. We are not recognized stakeholders at any stage in the game. Pharmacy school applicants, chains, hospitals, PBMs, government, doctors, patients are pharmacy stakeholders with voices. Still without us there is no pharmacy.
But there may one day be.
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Awesome! The people just need to get used to it. Lonely or not the pharmacist not the tech has the clout. I hope they don't tie it into your metrics forcing you to use the tech.- Joined
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I get it, Big Box uses this to leverage their refill reminder gig. I think Plan B's second theory (FTE MTM dept) would better serve us but his efforts on the dispensing end can still set the ball rolling.
The tech calling IMO:
1. is ghetto
2. is also likely to end up setting a precedent with the law
3. bastardizes the profession
The public largely has no idea what a pharmacist even does and at this rate they never will. Connections, not claims, are going to get the profession moving forward. I understand why the tech is calling, but it is a sellout move and is so freakin short sighted. I understand we have to keep the money coming to keep the employer out of our hair but this can be achieved without selling the farm.
The way I see it, we are not in the business, we are the business. Yet we have no voice. We are not recognized stakeholders at any stage in the game. Pharmacy school applicants, chains, hospitals, PBMs, government, doctors, patients are pharmacy stakeholders with voices. Still without us there is no pharmacy.
I agree with pretty much all of this.
I think I was speaking a bit hastily with regard to tech calls. I don't want technicians being the 'face' of mtm .. at all. And I didn't use technicians for any clinical work in my last implementation.
But.. you need to use them to do the basic stuff. At wags, we had technicians explain mtm benefit eligibility at drop off and pickup window , we had them alert the pharmacist on every mtm eligible fill so we could profile review to determine the depth of the claim value, and we had them do bookkeeping and scheduling of CMR. We also sometimes had them just initiate calls and ask people if they had time to speak with the pharmacist, but would hand off the call to us beyond that point.
We don't want this turning into pharmacy tech telethon. Whether it ends up being better to do within dispensing or done by dedicated FT staff I think depends on the district, patient base, and most importantly volume and store density. I'm in a relatively unique district right now that I feel could work the "in-line" system.
Ultimately i think we will see some form of mtm though, become a very large part of every retail rph's job.. but this may still be 10-20 years away. But walgreens new concept of having the pharmacist not do dispensing (currently on trial in a couple major metro stores) to me is an indicator maybe, of where this is all headdd
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I have a consulting business and in 2012 had a contract to do MTM (not through Outcomes or Mirixa, but another system) for state retirees. With the reimbursement structure, 800 patients was considered "full time." I started with 150 patients in Q1 and progressed to a high of 1500 patients in Q4. I made a lot of money. Enough that I did not regularly work for anyone else from the end of residency (6/30/12) until March 1, 2013 when I started part-time at Target. I did some teaching and relief work in the fall, but took some time off from that after having a baby in November. I picked up 1/3 of my Q4 patients after Christmas, where I did nothing but compliance reviews around the clock. Those patients were pulled back from other providers who could not complete them by the deadline. It was an awesome thing, and I wanted to continue, but the retirement system decided to go with another PBM who used their own in-house pharmacists starting 1/1/13.
I hired three pharmacy interns to do all the CMRs via phone, and they stayed with me through the end of residency. I kept one of them on staff and he remained with me as I devoted myself full-time to the business. He greatly improved my productivity. I also employed a retired professional to handle some of the "cold calling" stuff that no one likes. We'd get a list of patients who were candidates for CMR and had to attempt to reach each of them twice before we could do an abbreviated review (or a CMR if we reached them). I paid the woman I hired $1 per patient, whether she reached them or not. Most of the people never answered their phone or the numbers were disconnected. If she reached someone, she would explain the program and ask if they wanted the CMR or not. If they did, she'd add their names to a list and the student followed up. Easy enough.
It was great. I'd like to get something like that again, if the opportunity and timing is right. I was just hired by another company to review CMRs done by pharmacy interns, via Outcomes. It will be a nice way to make a little extra cash, I think.
I hired three pharmacy interns to do all the CMRs via phone, and they stayed with me through the end of residency. I kept one of them on staff and he remained with me as I devoted myself full-time to the business. He greatly improved my productivity. I also employed a retired professional to handle some of the "cold calling" stuff that no one likes. We'd get a list of patients who were candidates for CMR and had to attempt to reach each of them twice before we could do an abbreviated review (or a CMR if we reached them). I paid the woman I hired $1 per patient, whether she reached them or not. Most of the people never answered their phone or the numbers were disconnected. If she reached someone, she would explain the program and ask if they wanted the CMR or not. If they did, she'd add their names to a list and the student followed up. Easy enough.
It was great. I'd like to get something like that again, if the opportunity and timing is right. I was just hired by another company to review CMRs done by pharmacy interns, via Outcomes. It will be a nice way to make a little extra cash, I think.
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Wow! All this discussion got me wondering about telephone logistics. You answered my questions and more.
That you were able to navigate to the opportunity is remarkable in itself. I will keep my fingers crossed that you land a new op. Something tells me if it out there you will fish it.
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Is this directed at me?
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Yeah. Quote didn't come up, sorry about that.
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I made more than the average pharmacist makes in one year. Is that specific enough?
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More or less than 2x the average pharmacist's salary?
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Being my own boss would double the value alone but the experience is priceless. Even were high student debt a current factor, in the long run, a candidate w/ her background will be more employable as the market tightens. Imo fidallas over baseline salary = ass woopin.
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1500 eligible pts... if the plan is good and rph is good. . I could see netting 100-200k out of that in 6 months.
1500 eligible patients represents a great pool to start with , but isn't super easy to get that contract.
I would say I was working with a pop of around 3,000 moderate yield in my latest gig, across 2 districts. Cherry picking good claims as a student I was able to hit around $60/hr without doing many CMR or working too efficiently..
If you have staff and have the skills, the money is there.
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Interesting...do you think there will be a natural progression to move these mtm in-house by the PBMs over time?
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Well, I didn't have the large patient load for the entire year. I started small in Q1 and increased every Q. But if I had maintained that patient load for a full calendar year, it would have grossed somewhere in the neighborhood of 200K. I would have needed to hire additional help, though.
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For me it was timing and knowing the right people.
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The taxes were frightening. LOL
Even with all of the deductions I had.
Even with all of the deductions I had.
