Lawrence “LB” Brown, PharmD, PhD
Chair, Health Outcomes and Policy Research Division
Director of Graduate Studies in Health Outcomes and Policy Research
Director, UT Center for Medication Therapy Management
Health Outcomes and Policy Research Graduate Program
Pharmacist-Provided Medication Therapy Management
Dr. Brown is Associate Professor, Chair of the Health Outcomes and Policy Research Division, Vice-Chair of the Department of Pharmaceutical Sciences, Director of Graduate Studies in Health Outcomes and Policy Research, and Director of the UT Center for Medication Therapy Management (MTM) at the University of Tennessee College of Pharmacy. He completed his Doctor of Pharmacy degree at the University of the Pacific and his Ph.D. in Social and Administrative Pharmacy at the University of Minnesota. He began his pharmacy career as a U.S. Air Force Pharmacy Technician from 1985 to 1991. His main research interests are: Economic and Clinical Outcomes of Pharmacists-Provided Medication Therapy Management (MTM) Services, and consumer perception of pharmacists’ roles within the health care system.
“LB” is passionate about Medication Therapy Management. He has given over 20 invited presentations on MTM in various countries around Europe and Asia, and over 50 throughout the United States. Also, for the past eight years he has been assisting community pharmacists, in Hungary, offer MTM, and was recently awarded the “Medallion of the Association” by the Hungarian Private Pharmacists Association. He is former Speaker of the House for both APhA-ASP and APhA, and currently serves on the APhA Board of Trustees.
Additionally, Dr. Brown served on the planning committee and as a moderator for the 2005 AHRQ MTMS Expert Meeting, and on the planning committee and as speaker for UT’s 2006 International Symposium on Medication Therapy Management, and this year he has served as an expert for the Future of MTM forum in Minneapolis. He has served as co-chair of the Pharmacy Quality Alliance (PQA) Reporting Subgroup, and was co-chair of the Quality Metrics Subgroup for PQA. He is a past member of the XLHealth Medical Advisory Board, and holds joint appointments with the UT College of Medicine - Dept of Preventive Medicine, Xavier University College of Pharmacy, the University of Arizona, College of Pharmacy, and MARA University of Technology College of Pharmacy in Malaysia. He is currently a member of the Board of Trustees of the American Pharmacists Association, President of the Faculty Senate for the UT Health Science Center,and Parliamentarian for the American Association of Colleges of Pharmacy. He is also a former Grand Regent of the Kappa Psi Pharmaceutical Fraternity.
RxEconsult: When and how did you become involved with Medication Therapy Management?
Dr. Brown: My passion for Medication Therapy Management began while a pharmacy student at the University of the Pacific. I was fascinated with pharmaceutical care, but confused as to why so few patients were willing to have pharmacists provide the service for them. I started a patient education committee that went to various pharmacies around the city and set up a display board that had information about pharmacists and our education level. Patients seemed genuinely surprised at the years of school we went through, and that made me realize that we were doing a poor job of marketing ourselves to the public. So after pharmacy school I went to the University of Minnesota to get my PhD in Social and Administrative Pharmacy and did my PhD on pharmaceutical care. And during that process I realized just how strong of a stereotypical image most patients have of pharmacists, and it was that image that was holding us back. After my PhD program I took a faculty position at the University of Tennessee and continued my work of trying to better understand the perceptions that patients have of pharmacist roles in the health care system, so that we can start to break through that stereotypical image.
RxEconsult: What is the vision for the University of Tennessee Center for Medication Therapy Management and how is the center achieving its research, teaching, and patient care goals?
Dr. Brown: The vision of the Center is to be Nationally and Internationally known for conducting research that improves the environment for MTM to be provided by pharmacists. I’m talking about Expanded Demand, Expanded Supply, and Expanded Quality of Medication Therapy Management. Expanded demand means doing research that helps to expand the eligibility criteria under Medicare Part D, as well as expand MTM coverage to the non-Medicare population. Expanded Supply means doing research on how to make it more efficient for pharmacists to provide MTM in the community setting, as well helping pharmacists in other settings be able to provide MTM. Expanded Quality means doing research that helps MTM pharmacists provide a higher level of quality. We are doing great now, but we always want to be focused on how we can do better. In terms of teaching, this is my fifth year teaching the Medication Therapy Management course here at UT. Right now we are focused on the research and teaching, but we have plans to open an MTM clinic on campus as soon as we can secure some funding to get it started.
RxEconsult: How far are we into the MTM story? Since you started speaking nationwide about MTM what progress have you seen and what have you learned from your audiences?
Dr. Brown: It may not seem like we have come a long way down the MTM road, but in the past eight years I have been speaking on MTM there have been a lot of changes. For one thing we now have three major players in the MTM provider network space, and those companies are able to pay a lot more for MTM services than they used to. We have a lot more pharmacists that are providing MTM, and more chains have started encouraging their pharmacists to do MTM. That is a huge change. We have more recognition of the value of MTM by the Center for Medicaid and Medicare Services (CMS), and the health care reform bill from 2011 provides for a lot more opportunities for pharmacists to provide MTM. We have a lot more pharmacists providing MTM as part of a Medical Group, and more and more pharmacists are being contacted to see if they are interested in being a part of an Accountable Care Organization (ACO). But one change that many people are not aware of is how many more pharmacists we have working for CMS, AHRQ, and other governmental agencies. The new Center for Medicare and Medicaid Innovation (CMMI) is a great example.
RxEconsult: How do we establish MTM as part of routine healthcare practice and what will it take?
Dr. Brown: I would say to look for the results of several CMS Innovation grants to help answer that question. I think you would be surprised by the number of innovation grants that included pharmacist provided MTM as a component of their grant. And the best thing about the Innovation grants is that a requirement of the grant is to have the health care innovations be self-funded by the end of the grant. This means that they would become an integral part of the health care system where they were tested, and then be replicated elsewhere. But overall, I think the move towards quality metrics in health care and pay for performance will incentivize more physicians, health plans, and hospitals to bring pharmacists on board to help improve quality and reduce costs.
RxEconsult: I have read on some boards that pharmacy is too divided and our organizations are not doing enough to advance the profession. What is the role of organizations like APhA and what is the responsibility of the individual in establishing MTM.
Dr. Brown: There is no doubt that on some issues, the pharmacy associations are divided, but from where I sit, we are less divided than we used to be. Although there are some issues where the associations have differing viewpoints, there are several others where we are speaking with the same voice. APhA, ASHP, AMCP, AACP and the other associations are working hard every day to advance the practice of pharmacy. I’m a member of the Board of Trustees for APhA, and I can tell you that our strategic plan is all about improving medication use and improving patient care. And that’s what MTM is all about. APhA has a policy group that goes out and takes the message of what pharmacists can do to legislators and others on Capitol Hill. And the APhA Foundation is doing its part by funding research that shows the value of pharmacists provided MTM, like Project Impact Hyperlipidemia and the Diabetes Ten City Challenge. But the associations can’t do it alone. Pharmacists need to reach out to their elected officials and make the same pitch. Invite them to your store so they can see first-hand what pharmacist can do. And encourage your patients to let them know how much your MTM services have helped them. It’s these personal stories that help the most.
RxEconsult: Community pharmacies in Hungary practice MTM? Please tell us more about your international lectures and the practice of MTM in other countries.
Dr. Brown: Community pharmacies in Hungary are trying to get MTM going. Right now, most of it is limited to doing blood glucose and lipid screenings. The pharmacy education in Hungary has yet to include the type of therapeutics and MTM education we get here in the U.S., so for them doing screenings is a great first step. I’ve been a plenary or keynote speaker in several countries including Korea, the Philippines, Hungary and South Africa, and I regularly attend the International Pharmacy Federation Annual meeting. I can tell you that you can find countries along the entire MTM spectrum. Some are far behind the U.S., but some countries like the U.K. and Australia are ahead of us. And whether the country has a private health care system like ours or a socialized system, the pharmacists are facing some of the same challenges as we have. It is my view that pharmacists around the world deserve to be able to provide MTM and patients around the world deserve to be able to benefit from it. So I do all I can to help pharmacists become more knowledgeable about MTM and to get started doing it.
RxEconsult: How do we change the consumer’s perception of the pharmacist’s role in health care?
Dr. Brown: Wow, what a great question. I could talk for hours about this subject, but let me see if I can try to put it succinctly. To change consumer’s perception, they have to see something different. The fact that you can now get a flu shot at almost any pharmacy is a good example of that. When pharmacists first started doing this, patients were skeptical, but now most patients wouldn’t think twice about getting flu shot at the pharmacy. The next thing pharmacists can do is to let each patient know that during the filling of their prescription the pharmacist provided a quality check to make sure there were no drug interactions, that the dose wasn’t too high, and that the patient wasn’t allergic to the medicine, etc. Right now, most patients think that pharmacists just check to make sure the right medicine is in the right bottle and that the label matches what the doctor wrote. They also have no idea how many years of education a pharmacist has. And the saddest thing of all, is that patients have no idea that any other pharmacist except a dispensing pharmacist even exists, so they definitely don’t know what pharmacists do. I wish that each pharmacy would have a sign in the store that just lists all of the different clinical pharmacy specialties and all of the other types of pharmacists. That alone would open up patients’ eyes. But unfortunately, the main thing that is damaging our image is the lack of patient counseling. How can a patient possibly value us for the knowledge we have, when they rarely have access to that knowledge. And I’m not talking about just reading the label to the patient, because as patients say “I can do that myself”, but providing some value-added information. You would be surprised how many patients think they understand the directions, but really don’t. They take a BID dose at 7am and at noon. Why? Because the label just says to take it twice a day, and they took it twice in one day. And would you believe that patients who have an auxiliary label that says “Take on an empty stomach”, will wait two hours to take their other meds because they think taking another medication at the same time means that they will no longer have an empty stomach. So imagine how thankful patients would be if more pharmacists actually explained things to the patient rather than just leaving it up to them to understand.
RxEconsult: What are the basic skills needed to establish and run a successful MTM practice?
Dr. Brown: Man, another good question that I could talk forever about. But let me say that the first basic skill a pharmacist needs is the ability to care. I think it was Dr. Bob Cipolle from the University of Minnesota who said “Patient won’t care how much you know, until they know how much you care.” You also need good listening and communication skills. You need to have the ability to identify and resolve drug therapy problems. And you need to have the desire and ability to market yourself and the services you provide to other health care professionals in the community as well as to patients. There is a lot more detail than that, but those are the most important things.
RxEconsult: How will the current shortage of pharmacy jobs affect the adoption of MTM?
Dr. Brown: I know that it may seem strange, but I think the shortage of jobs is the very thing we need to push MTM forward. This means that new graduates are going to have to market themselves and try to create an employment opportunity where none exists right now. And the main way to do that is by marketing their skills in MTM. So I think you will see a couple of things happening in the next few years. You will see more graduates market their services on a contract basis for MTM opportunities that the pharmacies don’t have time to provide. You will see them getting hired by physician groups to help manage medications. And you will see more of them contracting with self-insured employers to provide MTM. All of these settings have a need that a pharmacist can fill.
RxEconsult: Can you paint a picture of what you think the pharmacy profession will look like 20 years from now?
Dr. Brown: We will make far more advances in the next 20 years, than we have in the 20 years since Hepler and Strand introduced us to Pharmaceutical Care. Twenty years from now, most pharmacies will look and act totally different than they do now. The pharmacist will be on the other side of the counter interacting with patients. Community pharmacy MTM will be as common as flu shots are now. Hospitals will have ambulatory care pharmacists on staff to manage patients with high readmission rates. And maybe in 40 years, physicians and nurse practitioners will diagnose patients with chronic conditions, and then pass them over to the pharmacist in their office to prescribe for and manage the patient’s condition. And pharmacists will be seen as the heroes who revolutionized the health care system, by decreasing health care costs, preventing hospitalizations, and basically keeping most people healthier and happier.
RxEconsult: Dr. Brown thank you for sharing your insight, vision, and your efforts to advance the practice of MTM and the pharmacy profession. Sometimes there needs to be a change catalyst and I agree with you that shortage of pharmacy jobs could be that catalyst. Pharmacists will be forced to innovate because they have no choice. Let me extend the RxEconsult platform to you and your students to use for sharing of knowledge about your program and developments in the pharmacy profession. I wish you success and I look forward to inviting you back in the near future.
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