Health Plans

Medicare Health Plans

MTM FOR MEDICARE PART D

Medicare Advantage and Part D plans have very specialized medication therapy management (MTM) needs. Since 2010, MTM programs have become more and more regulated. In 2014, the Comprehensive Medication Review (CMR) was made a STAR measure and in 2015, CMS included the MTM program as a component of the Medicare program audit. In sharing our clients’ commitment to quality CSS provides more than a “check the box” program. Through our proprietary MTMPathTM software platform and a team of experienced management, account support, and clinicians, CSS’s standard Part D MTM program ensures regulatory (CMS) compliance, financial ROI and STAR improvement. Thanks to the flexibility of our MTMPath software and customizable solutions, our clients can extend their MTM programs to address non-MTM eligible members around focused issues through our add-on programs

CMR DELIVERY

Our software has been designed to provide your plan with maximum flexibility in the delivery of CMRs.  Depending on your available clinical resources, you can:

  • Outsource your entire MTM program to CSS
  • Leverage CSS’ clinical team to support your current MTM program
  • License CSS’ web-based MTMPathTM to streamline your operations
  • Let CSS help you build a network of MTM clinicians.

Regardless of your desired level of involvement, we will work with you to develop a successful MTM program to meet your goals.

LICENSE OUR MTMPATH™ SOFTWARE

CSS’s MTMPathTM platform provides a turn key solution for your Part D MTM program.  MTMPathTM is a cloud solution.  Implementing our cloud solution is a “light” lift for your IT team.  Because all you need is a computer with an internet connection. MTMPathTM is very mobile so you can use the platform at the office, pharmacy, patient’s home, long term care facility or physicians office and clinic.  MTMPathTM is fully configurable and conforms to your CMS submission. Learn more or request a demo.

REPORTS

CMS-mandated reports come standard with all of our programs.  Both Beneficiary Level Report (BLR) and Universe Audit File are available through the MTMPathTM Program Dashboard and can be run on demand. CSS’s standard MTM program also provides a library of administrative, clinical and outcomes reports. All reports are made available through the Program Dashboard and can be run on demand.  If that’s not enough, CSS will build custom reports to provide the data you need to manage your MTM program.

DATA VALIDATION AND CMS AUDITS

All of our clients benefit from CSS’ Data Validation and Audit support services.  We fully support our clients during the validation and audit process, providing policy and procedure documentation and participating in audit calls.

Medicaid Health Plan

MEDICAID HEALTH PLAN MTM SERVICES & SOLUTIONS

As a Medicaid Health Plan, you know the challenges of improving the wellness and safety of your members while looking for financial savings. At CSS, we understand your difficulties, and we share your goals. We wrote our mission statement with you in mind.

The well-being of your members is of the utmost importance to us. Our medication therapy management services and solutions are pharmacist-informed, ensuring that your members’ medication regimen is safe and effective. If you choose, our skilled nurses and clinical staff will perform outreach to your members, giving them the education, empowerment, and support they need to make proactive choices about their health.

WE VALUE WELLNESS AND COST SAVINGS

Of course, healthy and adherent members will translate into cost savings for you. If your members are taking their medications properly, and are on an allergy and interaction-free regimen, they are less likely to seek additional, preventable medical care. Fewer unplanned trips to the hospital, urgent care, or doctor’s office will mean fewer preventable costs for you. Our MTM services and solutions seek pharmacist-approved, low-cost medication alternatives for your members. This simple process will help you eliminate unnecessary costs while helping your members achieve their best health.

WE GIVE YOU OPTIONS

CSS offers several MTM solutions designed with the pain points of a Medicaid health plan in mind. You can build your own program by pairing together the solutions that will address the areas that need the most attention, such as adherence, formulary alignment, drug-drug interactions, and chronic disease state management.

For nearly 2 decades, pharmacists and technologists at CSS have built and curated a world-class clinical recommendations engine to power MTM and other clinical programs to improve patient care.

CLINICAL RECOMMENDATIONS ENGINE

We understand the value of achieving successful outcomes for your programs. Our sophisticated data management processes allow for robust reporting and data extracts to meet your needs.

ROBUST REPORTING & ANALYTICS

We have a powerful suite of tools that put you in complete control of your programs. Customize your business rules, track progress and manage all program elements with ease.

CLINICAL PROGRAM MANAGEMENT

We continue to be leaders in ensuring our customers are at least two steps ahead of regulatory changes that may be on the horizon, including the ability to fully support you during audits.

FRONT LINES OF REGULATION

We offer a variety of add-on solutions and 3rd- party integration options to ensure every element of your clinical programs is addressed, including phone systems and print/mail/fax provider integrations.

ADD-ON SOLUTIONS TO FILL GAPS

Fully customize your complete program, including all communications to patients and physicians. Use only the components of the CSS solution you require. We can build a solution that's right for you.

CUSTOMIZABLE & MODULAR

The CSS Platform has the ability to deeply integrate with EHR/EMR systems using the latest in HL7/FIHR standards.

INTEROPERABILITY

We know how important your time is. That is why we guarantee service uptime and availability. We adhere to strict service level agreement requirements to ensure we’re always online when you need us.

SLA & UPTIME GUARANTEES

One of the most underestimated elements of clinical care is the workflow process, especially when patient contact is required. We allow work tasks of various types to be distributed to team members.

WORK DISTRIBUTION

Our Mission

We don’t just work for our clients, we work with them. From program design and implementation to ROI reporting, we make the success of your care program our priority.