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MTM Program For Dual Eligible Populations

MTM Program for Dual Eligible Populations

Recognizing the complex needs of the 10.8 million people estimated to be eligible for both Medicare and Medicaid (“Dual-eligible” or “Duals”), CSS Health and Bridgewell Medical have partnered to develop and offer DualPath™, a Medication Therapy Management (MTM) program focused on addressing the issues most likely to burden this population.

The core of this program is CSS Health’s high-performance Medication Therapy Management platform (MTMPath™), clinical call center, and pharmacist network. Augmented by Bridgewell Medical’s provider-based ancillary care team, this program embeds clinical pharmacists and health navigators into the local community, where they partner with healthcare provider groups to resolve clinical care gaps and social needs as an extension of the primary care team.

The Duals population is:

  • Poorer (59% live below poverty income levels)
  • Less supported (31% live alone)
  • More disabled (32% report problems with 3-6 activities of daily living compared to 11% of non-Duals)
  • In worse health (19% report being in poor health compared to 7% of non-Duals)

The Dual Eligible population also consumes significantly more healthcare spending than non-duals populations. In 2013, they represented 18 percent of the Medicare FFS population but 32 percent of aggregate Medicare FFS spending.  Likewise, prescribed medications for the Duals population were nearly four times higher than for non-duals ($4,740 per person vs. $1,322).

As a result of these issues, the Duals population is prone to multiple socially-driven barriers to care (e.g., transportation, refill navigation, literacy), particularly when attempting to fill, refill and comply with prescription therapies.

“DualPath’s combination of aggressive medication management and compliance packaging overcomes barriers to care by simplifying and improving medication management for patients and significantly improves health outcomes,” affirms Dr. Jim Notaro, CSS Health’s Chief Clinical Officer. The program’s active form of MTM assures deprescription of legacy drugs and on-time compliance with optimal medication regimens.

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