Throughout his career as a pharmacist, Tom Halterman’s constant frustration was that he wasn’t allowed to serve in a more consultative role to his patients.

“I had gone to school for a lot of years to develop an expertise in the nature, action and use of medications,” he said. “I got out in the real world and found that all anybody seemed to care about, especially from a health insurance perspective, was how quickly I could take the pills out of the big bottle, get them into the little bottle and out the door.”

With the goal of improving health-care quality and reducing costs by helping people manage their medications more effectively, Halterman and a group of about 25 other Iowa pharmacists joined as investors in 1999 to form Outcomes Pharmaceutical Health Care LLC. The Des Moines-based company, which now works with a network of about 4,000 pharmacists nationwide, has been a pioneer in using technology to help pharmacists deliver medication therapy management services across the country.

Outcomes’ group health plan clients have seen savings that range from $1 for every dollar spent in fees, up to $12 for one of its most medication-intensive Medicare discount card clients, according to Halterman.

“Even for an employer that’s seeing a 1-to-1 return; it’s a quality improvement program at its heart,” he said. “So if you can improve health-care quality and break even, you’ve still got a win there. What everybody wants to do is improve health-care quality and save a lot of money. That’s the home run. But even if you improve health-care quality and break even, you’ve still hit a double.”

Medication therapy management is still a relatively new concept in the industry, said Tom Temple, executive vice president and CEO of the Iowa Pharmacy Association.

“I think the market has been focused on just trying to get the drug cheap rather than focusing on the outcome,” he said. Some studies have estimated for every drug dollar spent, however, another dollar is spent to correct mistakes from its incorrect use, Temple said.

Beginning in February, Wellmark Blue Cross and Blue Shield and the Iowa Farm Bureau Federation plan to participate in a pilot program with the pharmacy association to test the use of a medication therapy management program, Temple said. That project, which is based on a program now used by the Iowa Medicare program, will focus on patients who are taking multiple medications for chronic health conditions.

Outcomes, which has had this niche largely to itself for the past six years, anticipates significant competition next year when the new Medicare Part D prescription drug benefit goes into effect Jan. 1. The new program requires that every health plan offering Medicare prescription drug coverage must include a medication therapy management services component.

“Our primary competition to date has been the choice to do nothing,” Halterman said. “I think having more people out there talking about it will further develop this market and get more people out of the camp of doing nothing.”

The pharmacists who formed the company tested the concept before they incorporated, through a two-year demonstration project.

“It was through working with that project that we learned a tremendous amount about what the pharmacists could do, what the significant barriers were and what some of the patient reactions were,” Halterman said. “That really became the basis for writing the business plan for Outcomes.” Among its first clients were group plans for Ames city employees and the Plumbers and Steamfitters Local No. 33 in Des Moines.

The bulk of the company’s business, however, has come from outside the state. Outcomes now counts about a dozen health plans as clients, with approximately 1.3 million covered members throughout the 50 states and Washington, D.C.

“We consider our genre to be anything that pharmacists provide with their heads rather than their hands,” Halterman said. For a fee to the health plan that averages about $1 per month per covered member, Outcomes pays participating pharmacies to provide in-depth consulting services to enrolled patients.

The company recently signed a contract with CareFirst, the Blue Cross and Blue Shield provider that covers Maryland, Delaware and Washington, D.C., to provide its services to all enrolled Medicare members within CareFirst’s region.

Under the CareFirst program, each enrollee will be given the opportunity to consult with a specially trained Personal Medication Management Pharmacist for a “medication check-up,” according to Winston Wong, CareFirst’s Director of Pharmacy Management. “This gives the member an opportunity to discuss with the pharmacist all of his or her prescription and non-prescription medications, vitamins and supplements,” Wong said. “If any potential problems or cost savings opportunities are discovered, the member, the pharmacist and the member’s doctor will work together to address them.”

Wong also said that the Personal Medication Management Pharmacist will provide ongoing services to members, such as patient education, compliance monitoring, and assistance with non-prescription medications.

Using a secure online system built by Spindustry Systems, each participating pharmacist logs the consulting services provided to his or her patients. Outcomes then pays the pharmacies their service fees from a risk pool of premiums collected from the health plans.

“Probably the primary barrier we had during the demonstration project was that the pharmacists had to install a proprietary software system in their offices to document the program,” Halterman said. “We were able to build a documentation system that pharmacists could access on the Internet at little or no cost, so now all they need is a computer with Internet access to log on to our secure Web site to use our documentation system.”

Outcomes is also looking to the Medicaid market for clients. In July 2004 the Florida Medicaid program adopted its product for all of its Medicaid recipients to receive Outcomes’ services through their pharmacists. Other states’ Medicaid programs are considering the services, despite tight budgets, Halterman said.

“We pay these pharmacists for providing these services separately from the dispensing of medications,” he said. “So it’s certainly a prospect where you’re asking someone to spend a dollar to save two or more. It’s a tough time to even find that first dollar in a lot of Medicaid programs right now, but I think a lot of Medicaid programs are looking at it right now as a cost containment strategy.”