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MTM Solutions

MTM Medicaid

Improve Profitability by Reducing Costs Across Complex Disease Treatments

CSS Health’s MTM Medicaid solution helps organizations manage costs by improving adherence and improve overall health for patients with multiple or complex chronic conditions. Built for current and future needs, MTM Medicaid is the first market-ready offering that addresses anticipated CMS MTM mandates.

MTM Medicaid manages MTM across the full breadth of payer Medicaid member populations. This technology-driven platform analyzes over 300 targeted care gaps to identify at-risk members and improve HEDIS measures, with a rapid return on investment that typically ranges between 150% – 300%.

A Comprehensive, Scalable Solution, Right Out of The Box

MTM Medicaid installs with coverage for more than 90% of HEDIS measures, with proven scalability from tens of thousands to tens of millions of members. Customers receive immediate visibility into at-risk individuals across condition, prescription, and utilization, supplemented by ongoing evaluation of pharmacy, medical, and claims data.

Automated HEDIS measure analyses addressed at both physicians and members include:

  • Chronic disease and cancer screening
  • Diabetes and cardiovascular disease screening
  • COPD & asthma
  • Hypertension
  • Diabetes
  • Osteoporosis
  • Antidepressant medication
  • ADHD
  • Behavioral health
  • Adherence
  • Care transitions

Direct Impact in Member Health Outcomes

This intense focus on the percentage of daily compliance (PDC) helps ensure that PDC rates reach or exceed the critical 80% threshold. Key monitored conditions include: • Diabetes • Heart diseases • High cholesterol • Asthma • COPD

Typical wellness standards include A1C, blood pressure, MME, PDC, and MPR. MTM Medicaid also directly supports behavioral wellness programs, such as mental health.

Simplify Complicated Multi-Dose Medication Regimens

CSS Health’s compliance packaging, offered through Medicine-On-Time, enables patients to adhere to complex medication regimens through color-coded, by day blister-packs. Our robust national pharmacy network also plays an integral role in helping members manage their medications in a simple, timely, and affordable fashion.

Identify and Address Issues Across Pharmacy, Medical and Lab Services

CSS Health’s MTM Medicaid analytics enable instant evaluation of pharmacy, medical, and lab claims data for all members — or for discrete populations — to identify cost-ineffective programs instantly across the full breadth of medication review data. These potential improvements benefit both patients and pharmacies by:

• Simplifying and solidifying formulary management • Eliminating redundant and inappropriate therapy • Strengthening compliance • Preventing adverse drug events
• Increasing preventative activity • Improving therapeutic monitoring

This highly efficient, cost-effective program benefits all parties. Patients enjoy improved health, and pharmacies and providers generate lower operating costs.

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