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.
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:
Reduce medication-related health risks, engage your members in their healthcare and improve performance on HEDIS measures. Prompted by TIPs in our platform, our network of pharmacists works with patients and prescribers on the interventions you choose. Our extensive menu of MTM services address a number of key quality measures to ensure members are:
- Receiving appropriate assessments, screenings & care
- Effectively managing common disease states
- Prescribed appropriate therapies in alignment with current guidelines
Target members for the services that will benefit them. Comprehensive Medication Reviews (CMRs) can help ensure your most at-risk members are taking the right medications in the right way. Targeted medication reviews (TMRs) can support adherence to critical chronic medications, prompt transitions to cost-effective alternatives and address gaps in care.
After leaving the hospital, a member may struggle to make sense of a new or changed medication regimen, while also working to heal. Medication reconciliation, delivered by a community pharmacist, can ease that transition, ensuring the member has the right medications at home and understands how to take them. Reconciliation summaries help ensure the member, primary care physician and pharmacy are informed of the new regimen, with the goal of preventing readmissions for avoidable events.
Education is an important strategy to reduce adverse outcomes from opioid therapies. Community pharmacists are well positioned to help members understand the risks of opioid therapies and how to safely use these potentially high risk medications. Through our specially designed TIPs, OutcomesMTM provides pharmacists with specific, actionable interventions to address this sensitive topic with your members:
- Education on safe use and disposal for a short term, short acting opioid therapy
- Assessment for adverse events and adequate pain control from a long term opioid therapy
- Initiation of Naloxone for members taking a long acting opioid or using an opioid in combination with a benzodiazepine
Behavioral patterns, social circumstances and environmental factors can impact a member’s health as much as or even more than medical determinants. Because each member’s blend of social determinants is unique, identifying areas that negatively impact the member’s health requires personal interaction from a trusted healthcare provider. Community-based pharmacists in our network are well positioned to initiate this sensitive conversation and potentially connect the member with local support or resources.
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 most expensive for you and your members.
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.