Comprehensive MTM program components

Patient-centered pharmaceutical care, delivered by practitioners, is the cornerstone of our comprehensive medication therapy management services. Pharmaceutical care optimizes the benefits of medications for individual patients. Under our comprehensive MTM services, each participating member receives medication therapy management services from specially-trained practitioners who will:

  • Address patient questions or concerns regarding therapies
  • Assess how well current drug therapies are working
  • Review the patient’s understanding of all medications
  • Review patient history and health status
  • Discuss the goals of prescribed and non-prescribed therapies
  • Collect information to identify, resolve and prevent drug therapy problems
  • Generate and provide a personal care plan and medication list to the patient and, with the patient’s consent, to healthcare provider
  • Establish the date and expectation for follow-up

We can provide a robust end-to-end comprehensive medication therapy management service which includes data analytics, eligibility criteria application, member recruitment, member enrollment, scheduling of pharmaceutical care delivery by practitioners, network administration, call center service delivery, outcomes reporting and CMS-compliant program reporting. These services are available on an a la carte basis.

Our comprehensive medication therapy management services exceed the Medicare Part D MTM Program Requirements set forth by CMS in its 2010 Call Letter dated March 30, 2009.

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Enrollment, Ongoing Recruitment and Follow-Up

We can employ the following recruitment and enrollment strategies upon MTM program implementation and each quarter thereafter targeting “first time” medication therapy management eligible members:

  • MMS will integrate Part D member demographic and eligibility data and pharmacy claims data provided by client into the Assurance Pharmaceutical Care System™ in order to identify MTM eligible members meeting client’s MTM program requirements.
  • MMS will mail to the assigned home address of all MTM eligible members, a letter of notification of eligibility to participate in the comprehensive MTM service. The letter will emphasize that the purpose of the comprehensive medication review encounter with the MTM practitioner will be to optimize and individualize drug therapy. The letter will provide detailed instructions on the process for participating in the MTM service, and for opting out of the program or elements of the program. All communications to MTM eligible members by MMS are approved by client prior to distribution.
  • Within 10 working days of mailing of the eligibility letter, MMS will initiate up to three telephone outreach attempts to contact each “first time” MTM eligible member to verify member’s desire to participate in a comprehensive medication review or to document the reason for an “opt out”.
  • Each MTM eligible member who has verified participation will be contacted by telephone to schedule an appointment for comprehensive medication review encounter with an MMS practitioner.
  • MMS will track all opt-outs and record the stated reasons. MTM eligible members may request disenrollment from the comprehensive MTM service at any time, for any reason. At client’s request, MMS will mail an “opt out” notice to such members.

MMS believes that the above recruitment and follow-up procedures are in accordance with CMS’s expectation that Part D sponsors drive participation and follow-up with beneficiaries that do not respond to initial offers for MTM services.

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Annual Comprehensive Medication Review

The annual comprehensive review for each MTM eligible member participating in the comprehensive MTM service can be performed as either a face-to-face interaction with a pharmaceutical care practitioner in MMS’s Pharmaceutical Care Practice Network or by telephone in the Pharmaceutical Care Call Center.

MMS’s MTM program includes review of prescription, over-the-counter medications, herbal therapies, and dietary supplements. The review will include an understanding of the patient’s medication experience, a review of systems, a medication history, a current medication profile, a review of allergies and adverse drug reactions. This review will result in the identification of drug therapy problems preventing the member from achieving desired goals of therapy. This assessment will result in a personal care plan developed for each participant. The care plan will involve patient-specific goals of therapy and interventions necessary to optimize the patient’s medication experience. Each encounter with a pharmaceutical care practitioner by definition includes a “comprehensive medication review”. All comprehensive medication reviews will be documented in the Assurance Pharmaceutical Care System™ and MMS will mail MTM deliverables to the member and primary physicians.

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Targeted Medication Review

For each member receiving a comprehensive medication review, on a quarterly basis, an MTM practitioner will evaluate updated pharmacy claims records in the Assurance Pharmaceutical Care System™ in order to determine if recommendations communicated in the comprehensive medication review have resulted in desired outcomes. A follow-up MTM encounter may be scheduled with the member based as dictated by the targeted medication review. Written documentation of the actual patient outcomes, new drug therapy problems and appropriate interventions for their resolution will occur each time a practitioner  encounter occurs. All members receiving a targeted medication review will be mailed updated MTM deliverables reflecting the follow-up assessment of the practitioner. MTM service deliverables to members and providers written documentation of the assessment by the practitioner, whether face-to-face or by telephone, is provided to members who have received pharmaceutical care and to their prescribers.

In addition, the Assurance Pharmaceutical Care System™ contains functionality which allows each pharmaceutical care practitioner to create and provide an individualized educational aid or medication action plan for each member receiving comprehensive MTM services at the conclusion of each MTM encounter. MMS can incorporate client’s branding, content, and other desired educational materials for distribution to members by pharmaceutical care practitioners upon completion of documentation of each MTM encounter.

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Reporting and Outcomes Measurement

MMS will provide client with all of the information necessary to meet CMS reporting requirements, including:

  • the number of annual comprehensive medication reviews
  • the number of targeted medication reviews
  • the number of provider interventions, and
  • the changes in therapy directly resulting from the MTM interventions 

MMS’s Assurance Pharmaceutical Care System™ already contains demonstrable functionality and data to report outcomes that CMS may require in the future. These parameters include:

  • the number and type of drug therapy problems (this includes unnecessary drug therapy, inappropriate doses, drug interactions, adverse drug reactions and compliance levels)
  • clinical outcome parameters for the targeted diseases (HEDIS criteria met, etc.)
  • customer satisfaction.

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