Medication Therapy Management

Medication Therapy Management Services that Increase Adherence and Improve Star Ratings

Backed by 20 years of population health management experience and knowledge of CMS guidelines, our medication therapy management (MTM) program helps payers improve therapeutic outcomes, minimize medication complications, reduce unnecessary spending, and increase revenue. Our end-to-end MTM solution includes comprehensive medication reviews and medication adherence services delivered by an expert team of pharmacists, registered nurses, and medication specialists.

Medication Adherence

Poor medication adherence costs the industry up to $2901 billion a year.  In fact, studies show that up to 50%2 of medications are not taken as prescribed and up to 30%3 are never filled. Reasons for medication non-adherence vary from person to person; improving outcomes requires an individualized approach to member outreach, education, and support.

Health Dialog’s medication adherence program delivers the right engagement to the right person at the right time. We deliver a cost-effective and proactive intervention program that helps individuals overcome barriers to therapeutic compliance and sustain long-term behavior change. Program components include:

  • Powerful analytics to identify and prioritize individuals who are likely to be non-adherent to drug therapy guidelines; we can also predict receptivity to engagement and preferences associated with outreach
  • Personalized telephonic engagement focused on resolving medication issues and helping individuals overcome barriers to adherence
  • Support for medication adherence Star ratings and display measures (for diabetes, hypertension, and statin use)
  • Continuous evaluation and monitoring of medication adherence and long-term clinical outcomes

Comprehensive Medication Reviews (CMRs)

CMRs are a critical component of the Five-Star Quality Rating System for both MA-PD and prescription drug plans (PDP)—and yet, in 2016, completion rates for this metric were only 30.9% and 15.4%4 respectively. Health Dialog’s team of registered nurses, pharmacists, and medication specialists deliver CMR services that help payers meet CMS guidelines and uncover opportunities for improving medication use. Program components include:

  • Analytics to identify beneficiaries eligible for CMRs (based on CMS and health plan parameters) and to prioritize those likely to be receptive to outreach
  • CMRs conducted by our pharmacy services team to assess an individual’s medication history and identify issues that need immediate attention
  • Formulary based recommendations to increase the use of more cost-effective therapeutic alternatives
  • Post-outreach documentation, including a beneficiary’s personal medication record and medication action plan, developed using CMS standard formats
  • CMS-mandated reporting as well as a library of administrative, operational, clinical, and outcomes reports
  • Quarterly targeted medication reviews to monitor post-outreach adherence, pinpoint unresolved medication issues, and identify potential adverse drug-to-drug interactions

Related Solutions:

 

1 NEHI
2 World Health Organization
3 Journal of General Internal Medicine
4 CMS

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