Terrapin Pharmacy Medherent Program

Program Description

In 2015, to improve medication adherence and utilize staff resources more effectively, Cornerstone Montgomery joined with Terrapin Pharmacy to introduce Medherent™ into its residential program. Medherent™ is a patented medication adherence technology platform developed by Terrapin Pharmacy to improve medication adherence among individuals with severe and persistent mental illness. Medherent™ is integrated into Terrapin’s pharmacy system and incorporates (1) a patented personal in-home medication dispensing device operated and controlled by an embedded Android tablet, (2) patented proprietary software that electronically monitors and records individual adherence behavior in real time, and (3) proprietary mobile and web-based applications that provide caregivers and medical professionals with real time information relating to an individual’s current medications, medication changes, prescription refill requirements, and adherence. Medherent™ dispensing devices were placed in the bedrooms of 30 Cornerstone participants. The devices were installed and loaded with medication. The devices were maintained and reloaded with medication on a bi-weekly schedule. Participants are alerted when to take their medications and receive a reminder every 15 minutes until they activated the unit. Participants and staff were instructed on how to use the device. Cornerstone staff was also trained on the mobile and web applications that enable remote monitoring and intervention.

Creativity

Medication non-adherence is one barrier to recovery of individuals with SPMI. Cornerstone expends substantial staff and financial resources sending counselors daily to monitor participants in their homes. Medherent™ enabled Cornerstone staff to reduce in person visits while making informed and responsive interventions to adherence and medication issues. Specifically, Medherent™ improved adherence by (1) simplifying the entire medication management process for participants (2) providing staff with real time non-adherence information enabling immediate intervention with participants when necessary and, (3) giving prescribers participant specific medication and adherence data to assess drug therapy effectiveness or ineffectiveness based upon objective reliable information. By accessing and integrating diverse and unrelated technology platforms, Medherent™ helped Cornerstone Montgomery improve its medication management by providing real time data, remote oversight and confidence that medications were available and accessed correctly. Most importantly, participants gained independence and empowerment that permitted them to participate more fully in their treatment and recovery.

Leadership

Cornerstone Montgomery and Terrapin Pharmacy worked collaboratively to insure the effectiveness of the design, implementation, and ongoing success of the Medherent™ program. The organizations’ staffs remain in daily contact coordinating the medication regimens of the participants including reviewing data relating to prescription refills, renewals, and discontinuations. Terrapin looks to Cornerstone Montgomery to provide guidance and recommendations regarding modifications and improvement in the Medherent™ platform and Terrapin’s services. Cornerstone Montgomery has been actively engaged in encouraging other agencies to implement the Medherent™ model. Cornerstone Montgomery staff members have made presentations to the Community Behavioral Health Association of Maryland (CBH) which is comprised of 53 member agencies committed to providing state of the art-treatment and services for individuals with mental illness. As a result of Cornerstone Montgomery’s encouragement, at least five other agencies have begun to utilize Medherent™.

Sustainability

Cornerstone Montgomery and other CBH members are committed to maintaining and expanding Medherent™. We believe studies currently being conducted will provide a compelling value proposition supporting sustained payment for the service by the agencies and eventually federal and state government programs. Cornerstone and CBH members are assisting Terrapin Pharmacy in applying for federal and state grants to fund expansion of the program including NIMH and Maryland Community Health Resources Commission. They have lobbied and testified in support of legislation introduced in Maryland to fund a Medherent™ pilot to provide the agencies with access to Medherent™. The goal is to have Medicaid and Medicare pay for Medherent™ to keep individuals living in place thereby reducing costs related to community-based and institutional long term care. Medherent™ has contracted to build a second generation of the dispensing device that will make 1000 devices available to agencies throughout Maryland in 2018 pending available funding.

Replicability

Cornerstone Montgomery’s program has already been adopted and implemented by a number of other mental health agencies throughout Maryland. Included among those agencies are Mosaic Community Services, People Encouraging People, Vesta Inc., and Arundel Lodge. The agencies have all acknowledged that Medherent™ has significantly elevated adherence and reduced the amount of staff time devoted to medication management of program participants. All agencies are requesting additional dispensing units. Terrapin Pharmacy has contracted to build additional units and continues to look for additional funding to support expansion.

Results/Outcomes

A study conducted by the University of Maryland School of Social Work found that Cornerstone Montgomery project participants accessed their complete medication regimen as prescribed at a rate exceeding 92% over a 12-month period. Their accompanying feasibility study showed that participants and agency staff readily embraced the technology. Preliminary results from an additional study revealed that the number of days of hospitalization for these individuals declined from 33 days to 3 days in the first full year of Medherent’s™ deployment. Cornerstone Montgomery is committed to identifying funding sources to expand Medherent™ to their entire residential program. Cornerstone Montgomery has calculated that Medherent™ has reduced the amount of time spent by staff responsible for medication monitoring by 6 hours per week. In addition, the number of medication errors reported by staff went from 8 to zero in the last year.