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Medicare Part D

CSS Health’s Medicare Part D Solution is flexible and audit hardened.

At the core of all of CSS Health’s medication management offerings is MTMPath™, the pharmacist EHR. It’s designed for high volume, high quality, reliable drug regimen review. You can configure your Part D MTM program exactly to your CMS program submission.

The CSS Health Clinical Call Center can provide you with full-service CMR outreach or support your team on an as-needed basis. Regardless of which option you select, your MTM program will be supported with regular, weekly reports by one of our Account Management teams.

  • Top Box CMR Rates. CSS Health’s standard program forecasts your CMR needs and provides you with the insights needed for high level CMR performance.
  • Audit Hardened. MTM Medicare Part D is an audit-tested program, with clients typically passing multiple CMS audits without issue.
  • Quality Add-Ins. Seamlessly add Adherence Improvement and other Quality Metric Improvement (SUPD, COA, etc.) programs to your MTM effort.
  • Program ROI. Calculate the direct cost savings or Total Cost of Care changes that result from your MTM efforts.

Contact your CSS Health representative to find out how our MTM Medicare Part D Solution and Smart™ patient assessment software can help you improve outcomes and reduce costs.

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Medicaid populations are different than Medicare populations—so a Medicaid MTM program should be designed differently. With CSS Health and MTMPath™, you have the ability to design your Medicaid program to suit your population’s needs. You can focus on a disease state (like behavioral health), a utilization problem (like adherence) or a therapeutic problem (like opioid overuse).

  • Drug Therapy Problems. Have your MTM team focus on the drug therapy problems that matter in a Medicaid population (e.g. opioids, children’s use of antipsychotics, etc.)
  • Deprescribing. Deprescribe complex regimens by eliminating legacy and inappropriate drug use.
  • HEDIS Quality Improvement. MTMPath™ comes complete with clinical rules to alert the clinician that a patient may not be addressing a particular HEDIS quality metric

Contact your CSS Health representative to find out how our MTM Medicaid Solution can help you manage costs by improving adherence and outcomes for patients with multiple or complex chronic conditions.

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Commercial and Self-Insured

Designed to help payer organizations reduce costs, improve quality of care, and promote wellness, CSS Health’s commercial and self-insured solutions will help you improve outcomes for both simple and complex disease states. MTM Solutions for Commercial and Self-Insured plans also address medication driven absenteeism, urgent care visits, and hospitalizations.

  • Inefficient Medication Use. Configure a MTM program that can address the use of High-Cost Generics and Non-Formulary medications.
  • Prior-Authorizations. Use your MTM program to follow up on prior authorized medications and ensure that they are delivering the clinical results that you and your patients are paying for.
  • Medical Pharmacy. A significant percent of your medical costs comes from drugs administered or infused in the outpatient setting. MTMPath™ combines both medical and pharmacy claims so you can address drug utilization regardless of where it occurs and easily identify therapy that is administered out-of-indication or in high-cost settings.

Contact your CSS Health representative to find out how our MTM Commercial Solution can help you improve outcomes, reduce costs, and boost HEDIS ratings.

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Pharmacy Benefit Managers

CSS Health and MTMPath™ provide a turnkey, white-label platform to provide your clients with MTM services. Design very simple DUR-like programs or very high intensity (e.g. Diabetes Coaching) programs.

  • Cost Effective Solutions. Load all of your clients’ data into the MTMPath™ platform and it’ll be ready to go when your client is ready to engage your MTM solutions.
  • Hierarchical Platform Design. Have each client’s data segmented into its own environment.
  • Flexible Program Application. Start and stop MTM programs tailored to your client’s needs.

Contact your CSS Health representative to find out how our MTM PBM Solution can help you control costs and provide competitive differentiation in an increasingly challenging marketplace.

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Provider Organization

More and more provider organizations, such as physician groups, are taking risk around the cost and quality of drug use. Typically, provider organizations struggle to coordinate their finite clinical pharmacy resources to identify and address the critical and high-volume drug therapy problems that persist in an at-risk patient population.

  • High-Volume, High-Quality Medication Regimen Review. The MTMPath™ platform was specifically designed to allow pharmacists to scale their caseloads. Increase the productivity and efficiency of your clinical pharmacy staff.
  • EHR Integration. MTMPath™ can integrate with multiple EHRs using community standard FHIR resources.
  • Clinical Call Center. CSS Health maintains a Buffalo, NY based Clinical Call Center. If your organization has limited clinical pharmacy resources or your clinical pharmacists need support for a large patient outreach, CSS Health can help.

Contact your CSS Health representative to find out how our MTM Self Insured Solution can help you save money and increase employee wellness.

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