Solutions for Health Plans

Delivering successful MTM programs has been the focus of OutcomesMTM® for more than 20 years. We collaborate with you to connect your members with specially trained pharmacists to improve care, avoid unnecessary costs and enhance your quality rating strategy. Results are reported back to you with an estimated ROI based on our Actuarial Investment Model (AIM®). Select your plan type below to see our suites of services, which can be tailored to your organization’s goals.

Essential Logo

Our CMS-compliant MTM program includes Comprehensive Medication Reviews (CMRs) and targeted medication reviews (TMRs) for your MTMP-eligible members. For Essential programs, OutcomesMTM® offers:

  • CMS MTMP application assistance
  • Identification of MTMP-eligible members
  • CMR completion rate guarantees
  • Program reporting: MTM activity, annual CMS requirements & data validation audit support
  • CMR Offer Service

Targeted MTM services are designed to help plan sponsors improve performance for key Star measures, including the triple-weighted adherence measures. Prompted by TIPs in the Connect™ Platform, pharmacists work with patients to impact adherence and optimize medication regimens. Pick the measures you want to focus on:

Our Services

OutcomesMTM® designs MTM services to meet CMS requirements, address quality measures, reduce healthcare costs and improve the outcomes of members’ medication therapies. We also work with health plans to design new targeted interventions to meet a specific need. Services are provided face-to-face or by phone, as best suits each member. The following services, when provided and documented appropriately, may be included in an OutcomesMTM program.

Comprehensive Medication Review

A covered member (or member representative) meets with a pharmacist to review his or her entire medication profile–inclusive of prescription and non-prescription drugs, herbal products and nutritional supplements–to detect any conflicts, duplications or cost-saving opportunities. When complications are detected, the pharmacist consults with the member and/or prescriber to address the issue. In follow-up, the CMR recipient receives a Patient Takeaway that includes an updated Personal Medication List and a Medication Action Plan.

Patient Adherence Consultations

OutcomesMTM offers a range of adherence services that vary in intensity and may be targeted to members who are non-adherent or at risk of becoming non adherent.

  • Adherence – Needs Check-in TIP: the pharmacist counsels the member on importance of adherence, identifies potential and/or existing barriers to adherence and works with the member to overcome any barriers
  • Needs 90-day Fill TIP: the pharmacist assists the patient in transitioning from a 30-day supply to a 90-day supply
  • Needs Refill TIP: the pharmacy proactively addresses refills
  • Adherence Monitoring Program: the pharmacist monitors adherence and connects with the member throughout the year to meet or exceed the adherence target
  • Medication Synchronization (MedSync): the pharmacist works to align a member’s chronic medications to a common fill date to simplify the refill process and encourage a regular conversations with the pharmacist to address any medication concerns.

Condition Management

Costs of treating chronic disease can increase exponentially without a multi-dimensional approach to mitigation. Disease Management interventions build a connection point with the pharmacist who can provide expertise and resources your member will need to manage their condition for years to come. A suite of personal interventions aid members in reducing adherence barriers, managing medication supply, optimizing regimens and understanding how to manage their condition. Our Disease Management solution can address a myriad of disease states, including the five most expensive:

  • Behavioral health
  • Congestive heart failure
  • CVD / heart disease
  • COPD
  • Diabetes

Medication Reconciliation (MedRec)

For members discharged from the hospital to home, the pharmacist reconciles the pre- and post-discharge medication lists, looking for omissions, duplications, interactions and dosing concerns; deactivates any open prescriptions for discontinued medications; and distributes summaries to the prescriber and patient to close communication gaps.

Prescriber Consultations

The pharmacist consults with the prescriber and the member to prevent, mitigate and resolve drug therapy problems (DTPs). Interventions may include, but are not limited to:

  • Closing gaps in care
  • Resolving adverse effects or interactions
  • Reducing use of unnecessary or potentially harmful therapy
  • Addressing dosing concerns
  • Recommending cost-effective alternatives

Patient Consultations

  • Needs Medication Assessment TIP: A pharmacist assesses potential adverse events from the use of a medication with a heightened risk of causing significant harm. The pharmacist determines if the member is experiencing adverse events, educates the member on options to address any concerns and assesses if the member’s relevant disease state is controlled.
  • Needs Patient Education TIP: the pharmacist counsels the member on healthcare topics such as annual exams, screenings, lab tests, disease management, etc. to help prevent future illnesses and ensure disease states are appropriately managed (i.e., well-child exams, comprehensive diabetes care or follow-up care for ADHD medication).
  • Needs Immunization TIP: the pharmacist discusses the importance of getting the vaccine and how the patient can receive it, possibly administering it on the spot.
  • Social Determinants Assessment: the pharmacist discusses with the member societal and domestic factors contributing to their health to assess potential changes to medication or adherence.

Have an RFP?

Our team actively responds to all requests for proposals. Contact us for more information by clicking the button to the right.