Medication Therapy Management

A Personalized Approach That Improves Member Care and Boosts Stars Scores

Medication Therapy Management
Medication Therapy Management

A Medication Therapy Management (MTM) program is required by many state Medicaid plans and the Centers for Medicare and Medicaid Services (CMS) for all Part D plan sponsors to ensure covered drugs are used to maximize therapeutic outcomes. The effectiveness of the MTM program is determined by exceeding CMS compliance requirements and the number of Comprehensive Medication Reviews (CMRs) completed. 

Some MTM providers use an automated recording to call members and ask them to call back for an appointment. Some providers have students or technicians complete part of the CMRs, while others require members to go to a retail pharmacy to receive a medication review. 

At Health Dialog, specially trained healthcare professionals, known as Care Navigators, conduct interactive, personalized telephonic CMRs, supporting a true impact in closing care gaps and increasing adherence, which in turn, improves CMS Stars Scores. Our MTM-certified Care Navigators contact each member directly for CMRs and adherence interventions. Members can receive advice on their medications, get their questions answered, discuss side effects and cost savings opportunities, and any other barriers to adhering to their medication. We also detect when beneficiaries are at-risk for opioid over utilization and complete CMRs to increase the safe use of pain medications.

Components of our MTM solution include:

  • Interactive, person-to-person telephonic CMRs and Targeted Medication Reviews (TMRs)
  • MTM-certified pharmacists and nurses
  • Spanish-speaking Care Navigators
  • Engagement through multiple communication channels
  • Customizable program based on covered medication quantities, annual cost threshold and number of chronic diseases
  • 13 CMS 5-Star clients and nine 4-Star clients
  • $300 cost savings per enrolled MTM member
  • 35% resolution of prescriber care gaps
  • 91% of prescribers stating Care Navigators improved outcomes
  • 100% of performance guarantees met
  • 100% of data validation audits passed