Quality Ratings (Star)
Medicare Star Ratings have placed great emphasis on quality-based metrics. Through OutcomesMTM's Targeted Intervention Program (TIP®), 9 of 36 Part C Star Measures and 8 of 15 Part D Star Measures are targeted for improvement. OutcomesMTM-contracted plans have outperformed the national average in all four triple-weighted Patient Safety Measures.
An estimated one-third to one-half of all patients in the U.S. do not take their medications as prescribed. The New England Healthcare Institute estimates that non-adherence, along with suboptimal prescribing, drug administration and diagnosis result in as much as $290 billion per year in avoidable medical spending. OutcomesMTM supports the Personal Pharmacist™ network with adherence-related data and tools to drive successful MTM interventions and behavior change.
Compliance with Centers for Medicare and Medicaid Services (CMS) regulations in MTM grows more complex each year. Whether it's Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs), the Standard Personal Medication List and Medication Action Plan or reporting and data validation audits, OutcomesMTM focuses on ensuring every detail of each of its programs has been reviewed for regulatory compliance.
Cost Trend Management
While the "generic cliff" promises to curtail health care spending growth, opportunities to manage medication spending without sacrificing quality of care remain. OutcomesMTM Personal Pharmacists are positioned perfectly to succeed at completing these interventions. OutcomesMTM utilizes its independently validated Actuarial Investment Model (AIM®) to quantify savings, report return on investment and offer aggressive performance guarantees.
Most employers today provide a wellness benefit to improve employee productivity. However, few programs focus on enhancing the employer's significant investment in medications. OutcomesMTM fits into any wellness program.