Part 1 of this series discussed the key aspects and health care benefits of patient-centered medical homes (PCMHs). Part 2 outlines the approval process employed by the National Committee for Quality Assurance (NCQA) to evaluate, grade, and recognize PCMHs. Primary care practice sites must develop an understanding of the various graded categories to enable them to focus attention on the critical components of a successful PCMH. Overall, the goals of NCQA\'s recognition standards are to enhance patient access and continuity to health care services, manage patient populations, plan care, provide each patient with support for self-care, track and coordinate patient care, and measure performance of both the clinicians and practice-site as a whole. In short, the standards provide a solid basis for primary care practice sites to evolve into a PCMH model.

OBJECTIVE: To assess Medicare beneficiaries\' willingness-to-pay (WTP) for medication therapy management (MTM) services and determine sociodemographic and clinical characteristics influencing this payment amount.
METHODS: A cross-sectional, descriptive study design was adopted to elicit Medicare beneficiaries\' WTP for MTM.
METHODS: Nine outreach events in cities across Central/Northern California during Medicare\'s 2011 open-enrollment period.
METHODS: A total of 277 Medicare beneficiaries participated in the study.
METHODS: Comprehensive MTM was offered to each beneficiary. Pharmacy students conducted the MTM session under the supervision of licensed pharmacists. At the end of each MTM session, beneficiaries were asked to indicate their WTP for the service. Medication, self-reported chronic conditions, and beneficiary demographic data were collected and recorded via a survey during the session.
RESULTS: The mean WTP for MTM was $33.15 for the 277 beneficiaries receiving the service and answering the WTP question. WTP by low-income subsidy recipients (mean ± standard deviation; $12.80 ± $24.10) was significantly lower than for nonsubsidy recipients ($41.13 ± $88.79). WTP was significantly (positively) correlated with number of medications regularly taken and annual out-of-pocket drug costs.
CONCLUSIONS: The mean WTP for MTM was $33.15. WTP for MTM significantly varied by race, subsidy status, and number of prescription medications taken. WTP was significantly higher for nonsubsidy recipients than subsidy recipients, and significantly positively correlated with the number of medications regularly taken and the beneficiary rating of the delivered services.

It has been one year--since January 1, 2013--that comprehensive medication review has been recognized as a medication therapy management (MTM) service that must be offered annually by Medicare Part D prescription drug plans to \"qualified beneficiaries.\" This requirement solidifies the Centers for Medicare & Medicaid Services\' commitment to ensure all beneficiaries, including those in long-term care facilities, receive quality MTM services. Consultant pharmacists, who have long provided federally mandated medication regimen review services, may have their first opportunity to be paid for the additional services that they provide to individual Medicare beneficiaries residing in those facilities.

OBJECTIVE: To study the feasibility and effectiveness of a discharge medication therapy management program.
METHODS: Quasi-experimental pre-post study design.
METHODS: Thirty-six-bed hospital within an extended care hospital.
METHODS: All patients admitted to facility from January 2009 to December 2009 (control) and February 2010 to January 2011 (program).
METHODS: Pharmacist review of anticipated discharge following 18-20 days of stay, with suggested medication changes communicated to physicians via patient chart. Agreed changes were implemented on the next day.
METHODS: Patient readmissions within 30, 60, and 90 days into the hospital system. Medication interventions were quantified as to type.
RESULTS: During the control period, 432 patients were followed, and during the intervention period, 369 patients were followed, with similar lengths of stay. In the intervention period, 565 medication interventions were attempted on 216 patients, with an 85.3% acceptance rate. The major intervention was discontinuation of medications. Mean maintenance medications per patient decreased from 10.57 to 9.46 in the intervention group, and daily medication doses per patient decreased from 17.95 to 15.73 (P < 0.001). Readmission rates were lower at 30 and 60 days in the intervention group, with a 90-day overall decrease in system readmission rate from 51% to 39% (P < 0.001).
CONCLUSIONS: The discharge medication management program was successful in decreasing both number and type of discharge medications via pharmacist intervention. Overall, patient system readmission rates were also significantly decreased in the intervention period.