Situation
MTM has been practiced since the 1990’s and was legislatively recognized with the Medicare Modernization Act of 2003, which required that Medicare Part D insurers provide MTM services to selected members. MTM was incorporated by the Centers for Medicare & Medicaid Services as a measure for Medicare Star Ratings in 2016.
The Clinical Pharmacy Services team includes 60 clinical pharmacists, pharmacy associates, and appeals specialists. We work collaboratively with infectious disease specialists, drug utilization review boards, practitioners, and health plans to achieve the health care and cost outcomes that you and your patients need.
We design MTM programs for broad populations or for patients with specific health concerns, such as diabetes, dyslipidemia, heart failure, hepatitis, hypertension, mental health, migraine management, post-myocardial infarction care, respiratory disease, asthma and COPD.
Challenges
Medical management is often challenging for patients with complex medication regimens due to chronic illness, incomplete medication histories or other issues. Appropriately prescribed medications and proper adherence can decrease unnecessary hospital visits, improve overall patient outcomes and reduce costs for health care organizations and state agencies.
Solution
Our team reviews patient medication regimens and histories, and develops evidence-based clinical intervention strategies. MTM services – which can be directed toward patients, caregivers, prescribers or pharmacies – include:
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Identifying patients with specific disease states using sophisticated queries
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Analyzing prescribing trends
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Intervening and offering medication recommendations designed to improve therapeutic outcomes
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Communicating recommendations to the patient’s primary care provider
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Calling patients to ensure they understand how to obtain and properly use the medications they need
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Providing culturally sensitive and easy-to-understand materials and training
Results
Clinical Pharmacy Services has become a sought-after partner for organizations seeking results-oriented solutions to containing pharmacy costs and improving patient outcomes. Our team works with UHealthSolutions, an affiliate of UMass Medical School, to enhance member experience and improve health plans’ federal Star Ratings. We have achieved comprehensive medication review completion rates that far exceed the industry standard.
Medicare plans can increase their federal Star Ratings by implementing an effective MTM program that focuses on patient engagement to ensure medications are being taken and are properly managed.