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MTM Solutions

Enhanced Adherence Programs

Improve outcomes, reduce costs, and improve Star ratings by preventing end-of-year drop-off in adherence

CSS Health’s Enhanced Adherence programs link multiple offerings into a concentrated combination of MTM software, adherence coaching, prescriber outreach, compliance packaging, and local pharmacies to deliver intensive outreach for frail and fragile individuals. These populations trend to lower adherence at year-end, adversely impacting both member health and payer Star ratings. CSS Health’s Enhanced Adherence approach directly remedies both situations.

Overcome Social and Financial Pressures that Limit Adherence

Members with complex medication regimens face a variety of challenges that affect compliance, such as:

  • Holiday seasons and family events
  • Medical interactions or side effects
  • Confusing instructions
  • Lack of transportation
  • Expense
Percentage daily compliance (PDC) numbers below 80% impact as much as 35% of these at-risk populations. CSS Health’s Enhanced Adherence offerings directly address these concerns, helping commercial, Medicaid, and Medicare programs maintain essential adherence standards and improve Star ratings for diabetes, blood pressure (RAS), and high cholesterol (statins).

Apply Active Intervention Where It’s Needed Most

By tapping the breadth of CSS Health’s software and service offerings, Enhanced Adherence recognizes potential issues and enables rapid responses, including:
• Analytics-driven recognition of at-risk members, supplemented by direct personal contact to review adherence and discuss patient concerns
• Cost reductions including benefits utilization review to manage medication expense
• Access to transportation for medical, rehabilitation, and pharmacy visits during inclement weather or when regular caregivers aren’t available
• Color-coded packaging to make it as easy as possible to follow complex medication regimens
• Close monitoring of patient alertness and overall condition to minimize drug interactions and side effects

Enhanced Programs helps organizations quickly deliver highly individualized interventions since these types of social challenges vary widely from patient to patient.

Proven Results

Customers using CSS Health’s Enhanced Adherence programs receive immediate and impressive adherence improvement by directly addressing diabetes, RAS, statins, and other Medicare triple-weighted measures. Retention rates hold as high as 93% for adherent members. As much as 11% of non-adherent patients improve to 80% PDC, with more than 40% of populations indicating a positive change.

Best in Class Reporting

Powerful, intuitive reporting tools help organizations measure PDC risks across at-risk populations for each regimen. By understanding the trends that impact adherence and combining this information with what members themselves list as reasons for non-compliance, payers gain the ability to target resources faster and more effectively to ensure adherence.

Compliance Packaging

Multidrug regimens with complicated timing schedules represent one of the leading causes of non-adherence. Individually configurable, color-coded packages with correct dosages and times improves compliance by simplifying what to take and when. These pre-packaged medications also increase patient safety by minimizing drug interactions.

Cost-Effective Local Pharmacy Delivery

No treatment regimen will be effective if the patient can’t receive or afford their medications. CSS Health’s nationwide pharmacy network includes more than 5000locations, with preferential pricing and both in-network and out-of-network premium options. Many locations offer medication delivery or patient transportation, with mail-order delivery available as another alternative to in-person pickup.

Flexible Configurations for Organizations of All Sizes

Intensive individualized intervention requires a flexible approach for payers. Not all organizations need the full breadth of CSS Health Enhanced Adherence programs. Others do. CSS Health works with each organization to deliver the level of service each organization needs, backed with exceptional customer support to ensure positive results for this crucial demographic and time of year.


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