When the Core Elements framework for MTM was developed at the inception of Medicare Part D, it envisioned a model in which MTM was delivered primarily through a community pharmacy network. Over time, we have come to realize that this model has its limitations in delivering consistent medication management services.
Yet CMS continues to increase STAR measure cut points and, for the near future at least, will continue to rely on quality metrics as the basis for measuring and rewarding health system performance.
In response, CSS Health is cultivating the best of both worlds. CSS Health has developed and continues to curate a clinical pharmacy delivery strategy that combines a centralized Patient Engagement Center with a local pharmacist network of professionals committed to providing clinical services that deliver medication safety, efficiency and quality.
Engagement Quality: Our Patient Engagement Center monitors and coaches patients. When we identify a patient who requires a more “high” touch approach to care we can identify clinicians in our Advanced Practice Network (APN) who are actively engaged in delivering a variety of clinical services. Given the broad variety of capabilities between pharmacists and pharmacies, CSS Health has profiled each pharmacist to determine the scope of clinical services they are actively engaged in providing. Using this data, your plan can engage a pharmacist network focused on delivering the clinical services your plan requires. Generally, the patient can pick from a number of pharmacy clinicians in their area. Moreover, our network is composed of community, ambulatory, long term and home care pharmacists who are adept at delivering services in an environment most suited to the patient. Finally, our Patient Engagement Center is not simply a “call center” competing with local pharmacists but rather works in concert with the APN to improve medication safety, cost and quality.
Outcome Measurement: Our network pharmacy pilots are creating some impressive results. To support the entire population, we deploy our pharmacist EHR (MTMPath™). In every patient assessment, the platform automatically identifies care gaps for at-risk members populations, including specialty, behavioral health and chronic diseases for every business line. In a recent evaluation of adherence improvement, when our clinical call center referred plan members for compliance packaging services adherence improved above 90% in each case. Moreover, this improvement was realized regardless of the adherence starting point. This is a significant finding for many plans who have resigned themselves to considering members at 30% PDC as irremediable.
New STAR Measures: Over the next two years, CMS will be deploying and testing new measures. Many of these will be pharmacy related. These new measures will require new technologies to engage hard to reach members for adherence and MTM programs. Plans will require methods for addressing these new measures. CSS Health is continuing to innovate and provide you with MTM program “bolt-ons” that you can quickly configure to remediate medication quality issues.
MTM Across Business Lines: At CSS Health, we have been providing MTM services for 20 years (before Part D)! We have always believed your MTM program should conform to your population and its needs. Our vision has always been that MTM should go beyond Medicare, to help Medicaid and Commercial members and support your ACO relationships. Our configurable MTM approach allows us to specify population specific MTM programs, optimize HEDIS and STAR measures and improve adherence as required by your population.
At CSS Health, we have built lovable MTM technology and engagement programs that combine both a high performing Patient Engagement Center with an Advanced Practice Network of community-based pharmacists committed and engaged in providing clinical services with the proven ability to drive quality and outcomes.