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MTM Solutions


Turnkey, white label MTM services for Pharmacy Benefit Managers seeking a competitive differentiator that adds value for payor clients across Medicare, Medicaid, and Commercial populations

CSS Health’s PBM MTM solution helps pharmacy benefit management organizations improve pharmacy management for their customers. By enabling customers to control costs and increase revenue through Star bonuses and improved HEDIS measures, PBMs using CSS Health gain a powerful incentive for signing new customers and retaining current customers through a unified MTM platform that operates across multiple lines of business.

Rapidly Identify At-Risk Populations to Improve Medication Adherence

MTM PBM’s advanced analytics identifies more than 2500 potential therapy gaps across pharmacy, medical, and lab claims data. Typical program areas include:

  • Diabetes management
  • Behavioral health, including both treated and untreated
  • Asthma
  • COPD
  • At-risk opioid management
  • Special populations, including MS, rheumatoid arthritis, hepatitis C, HIV, and oncology
PBMs who already deliver MTM services lower MTM overhead by increasing efficiency and effectiveness. Organizations with manual MTM processes gain a fast, intuitively designed system that saves time and allows essential resources to focus on other tasks.

Drive HEDIS Improvements and Star Cut Point Goals

MTM PBM helps drive revenue for PBM customers by automating the management of MTM Part D programs and more than 90% of key drug-related HEDIS measures. By making this scalable outreach available to customers, MTM PBM’s adherence monitoring quickly identifies at-risk members for intervention.

MTM PBM also helps customers match business goals to target HEDIS and Star objectives, whether achieving the advantages and bonuses of a 4 or 5-star rating or maintaining current levels for cost control. PBMs become their customers trusted advisors, providing the insights clients need to reach these goals as HEDIS and Star rating cut points continue to evolve.

Flexible Configurations for Organizations of All Sizes

CSS Health knows that there’s no such thing as a one-size-fits-all PBM solution. MTM PBM serves as a fully functional virtual extension, as well as augmented services for PBMs with existing MTM offerings. No matter the need, CSS Health’s MTM PBM provides the solution that helps pharmacy benefit managers control costs and provide competitive differentiation in an increasingly challenging marketplace.

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