MANAGED CARE
The selection of the most appropriate drug provides not only provides the highest quality of patient care, but, most often, is less expensive than inappropriate alternatives.
CSS has designed technology processes that provide advanced medication therapy management (MTM) solutions for managed care entities, including HMOs, self-insured entities (corporations, unions and employer purchasing groups), and third-party administrators.
Our MTM process can be can be outsourced -- using member claims and demographic data -- to CSS's experienced clinicians who utilize state-of-the-art VirtualClinic technology to provide therapeutic drug intervention services.
For managed care organizations requiring MTM software or assistance to comply with Medicare Part D regulations, CSS has available for license its web-based Medication Pathfinder software for use by pharmacists within the manage care organization, by a network of ambulatory pharmacists, or, alternatively, the process can be performed by CSS clinicians.
Therapeutic Drug Intervention Services
CSS offers a therapeutic drug intervention model which identifies, through pharmacy claims, medications shown statistically to be suboptimally prescribed. Our trained clinicians, with the assistance of our robust VirtualClinic technology, evaluate the claims by collecting a minimum data set of clinical information from physicians to determine instances where therapy appears to be out of guideline and sub-optimal.
When appropriate, the clinicians recommend and coordinate the therapy modifications with the physician, patient and dispensing pharmacist. The conversion process is seamless to the member patient, and there is no disruption of service at time of prescription refill.
The CSS conversion process ensures that the correct medication is being prescribed based on clinical analysis. CSS is the only company that offers this high-volume, clinical component to drug utilization reviews.