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:

Medicaid + Commercial

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
Advance Logo

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.

Additional Solutions

Medication Reconciliation

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.

Opioid Services

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

Medication Synchronization

Managing refills for multiple medications can be challenging. Through a Needs Medication Synchronization TIP, OutcomesMTM alerts pharmacies to members who may benefit from aligning their chronic medications to a common fill date. By simplifying the refill process and encouraging a regular monthly conversation with the pharmacist, MedSync can help patients improve and maintain adherence.

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)

To simplify the refill process, the pharmacist works to align a member’s chronic medications to a common fill date. Synchronizing fills can make it easier for the member to keep medications on hand and encourages a regular monthly conversation with the pharmacist to improve adherence and address any medication concerns.

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).

Have an RFP?

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