Therapeutic Case Management (TCM) is an opportunity for Pharmacists to work collaboratively with Physicians to help manage chronic disease patients with at least two co-morbid conditions. TCM provides non face to face service offered to patients with multiple (2 or more) chronic conditions, and billable service through a physician or a nurse practitioner. TCM is a continuous monthly service at no charge to the patient. The time spent for the delivery of TCM should be 20 minutes or more per 30/days or a month’s period of time in passing. Clinical staff and pharmacist are the ones who can deliver these services. Billing and payment under the Therapeutic Case Management Program can be utilized through Medicare and Medicaid.
The patient will have access 24/7 to WCRx Pharmacy to address their needs. This would be with clinical staff either employed or contracted with the doctor’s office and does not require a physician to provide direct supervision. This only requires general supervision, for services provided outside of the practice’s normal business hours. Services to be provided by clinical staff, would have direct oversight between the supervising practitioner and the clinical staff personnel who provide after hours services. An organizational structure is required to either of employment or contractual relationship between the clinical staff and the practitioner or practice.
The Scope of Elements
The scope of elements for the TCM service includes a care plan. It ensures a close relationship between a practitioner furnishing ongoing care for a beneficiary and WCRx Pharmacy clinical staff providing aspects of TCM services under general supervision. Also it ensures that this close working relationship is sufficient to render a requirement of a direct employment relationship or direct supervision to be unnecessary. WCRx Pharmacy will provide TCM and utilize clinical pharmacist, MD’S, Nurses, and clinical staff to ensure proper care plan development. A protocol will be established for any changes in health status within the chronic disease or the co-morbid conditions that the clinical staff person is reviewing for the patient.
The WCRx Pharmacy clinical staff will notify MD of all related and relevant issues related to the patient. These services are intrinsically non face-to-face care coordination services. Elements necessary at no charge to the patient at WCRx Pharmacy are 24/7 access to address the patient’s acute chronic care needs. WCRx Pharmacy TCM will provide all clients with a means to make timely contact with health care providers in the practice to address patient’s urgent chronic care needs regardless of the time of day or day of the week. WCRx Pharmacy provides continuity of care with a designated TCM (Therapeutic Case Management) or member (pharmacist) of the care team with whom the patient is able to have successive routine appointments (this could also be an incident to visit, conducted by the pharmacist). Care management for chronic conditions includes a systematic assessment of the patient’s medical functional and psychosocial needs, also a system-based approach to ensure timely receipt of all recommended preventive care services. Medication reconciliation with review of adherence and potential interactions as well as oversight of patient self-management of medications is also part of care management. In addition, WCRx Pharmacy will utilize state of the art algorithm technology which will provide proper therapeutic guidance for MD, patient, and pharmacy.
Coordination of Care
Coordination of care includes home and community based clinical services that provides for patients psychosocial needs and functional deficits to be documented on the patients EMR. Also includes enhanced opportunities for the beneficiary and any care giver to communicate with the practitioner not only via telephone access but also through the use of secure messaging (medical portals), internet or other non face to face consultation methods.