Medication Management Improvement System (MMIS) – Care Management
The original Medication Management Model program to improve medication use was designed for Medicare-certified home health agencies providing in-home nursing and rehabilitation services to patients aged 65+. The model was then translated from the home health setting and tested in three Southern California Medicaid waiver sites as part of a national Evidence-Based Prevention effort led by the US Administration on Aging (AoA).
The new model, the Medication Management Improvement System (MMIS), funded by the US Administration on Aging (AoA) as the “Community-Based Medication Management Intervention,” is a collaborative approach to identifying, assessing, and resolving medication problems in community-dwelling older adults receiving care management services. Specifically, the intervention was tested among functionally impaired, low-income seniors living at home under a Medicaid waiver program aimed at keeping people out of nursing homes. MMIS is currently being disseminated widely in California’s 1915(c) Medicaid waiver programs for elders, called the Multipurpose Senior Services Program (MSSP). The next stage will be to diffuse the model nationally, with funding from the John A. Hartford Foundation.
The effectiveness of medication management in care management programs is evident through the AoA-funded study. In this study of three Medicaid waiver sites, it was found that out of a total of 615 clients screened, 49 percent (N=299) had at least one potential medication problem. Twenty-nine percent of the 615 clients had a medication problem serious enough for the pharmacist to recommend a change in medication, including re-evaluation by the physician. For this intervention group (N=118), 61 percent of recommended changes were implemented.
Targeted medication problems: The MMIS focuses on identifying and resolving the four most common medication errors that researchers have determined are amenable to collaborative staff and pharmacist intervention in homecare programs. They are:
- Unnecessary therapeutic duplication;
- Cardiovascular medication problems related to dizziness, continued high blood pressure, low blood pressure, substantial (20-point) drop in blood pressure upon standing (orthostasis), or low pulse;
- Falls, dizziness, or confusion possibly caused by inappropriate psychotropic drugs;
- Inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs) in those with risk factors for peptic ulcer.
Core elements: The MMIS model contains the following core elements:
- Risk screening to identify potential errors and medication-related problems;
- Assessment of the client’s condition and adherence based on established guidelines
- Consultation between staff and pharmacist to develop a plan of action based on protocols; and
- Follow-up with physician and client to improve medication use
Software risk screening tool: The MMIS for care management agencies was adapted from the home health model to work effectively in hybrid medical/social or simply social model programs. While the MMIS first featured use of a risk assessment algorithm and the services of a consultant pharmacist to assist the care manager in assessing and resolving potential medication problems, Partners’ most recent development is integration of the screening into a care management software package (MMSPCare) designed for California’s waiver program. The software program is a computerized risk assessment and alert system that helps care managers identify potential medication-related problems among their elderly clients. This reduces the need for pharmacist consultation, limiting it to only those clients whose risk screening indicates a potential problem.