Clinical Support Services (CSS) has designed a proprietary, turnkey solution for providing Medication Therapy Management (MTM) services that utilizes pharmacy claims and clinical data to provide a comprehensive medication review.  It meets all of the regulatory MTM requirements that are outlined in the 2010, 2011 and 2012 CMS Call Letters.

Using the S-O-A-P (subjective-objective-assessment-plan) Note format, the web-based MTMPath™ allows users to construct a clinical protocol that guides them through the collection and recording of pertinent clinical-related subjective and objective information.  MTMPath guides the development of a patient profile, suggesting potential therapy-enhancing recommendations when accepted treatment standards are not being utilized.

In the S-O-A-P Note environment, the pharmacist can quickly generate recommendations that address the potential for adverse drug reactions and increase adherence to clinically warranted medications that can improve the beneficiary's quality of life, decrease symptomatology, and eliminate unnecessary drug expense.

Our Medication Therapy Management program protocol supports the following processes:

• Identifying targeted members (using the client's parameters)
• Streaming pharmacy, medical and lab claims into the software
• Obtaining and organizing clinical background information obtained from providers and beneficiaries
• Confirming and augmenting the clinical profile with subjective patient data
• Crafting recommendations
• Documenting outcomes

Built on a SQL platform, the data stored in MTMPath's patient registry is easily exportable, queryable and reportable to accommodate CMS's reporting requirements and allows sponsors to determine actionable quality assurance issues.

 

Medication Therapy Management Models

Clinical Support Services' MTM services can be deployed using a number of different models:

 

Internally by Managed Care Organization/ Payor (Licensing Model) Using MTMPath™ software, clinicians within a managed care/payor entity can provide MTM reviews as required by CMS. The software guides the clinicians through a robust poly-pharmacy review using administrative claims data, provider clinical data and member assessments. Medication action plans can be provided to both members and physicians.

 

 

Internally by CSS CSS's clinicians can provide comprehensive services on behalf of the managed care/payor entity under the CMS Call Letter for Medicare Part D providers.  From claims integration through CMS reporting, CSS can support the entire regulatory process.

 

 

Externally by Ambulatory Pharmacists (Licensing Model) CSS's network of community-based MTM pharmacists (Medication Pathfinder™ Network) can provide MTM services within the parameters outlined by CMS.  CSS can also create a pharmacy network, or support an existing one currently being utilized by the managed care/payor entity.

 

 

Customized Hybrid Model A managed care/payor entity can design its own program, using clinical staff from various sources.  Pricing and assistance with model development is available from CSS upon request.

 

General guidelines for performing a CMS-compliant MTM model follow.  Each step of the process relies on the MTMPath software platform:

• Identify potential MTM-eligible members from claims data
• Send welcome letter to member
• Engage member in either an in-person or telephonic outreach regarding health status
• Request clinical information from the prescribing physician
• Create medication action plan (MAP) that includes recommendations and personal medication list
• Distribute MAP to provider and member
• Monitor intervention status with quarterly follow-ups
• Report results to MCO throughout process

The Managed Care Organization (MCO) determines who performs each of the steps noted above; they can be performed by MCO staff, CSS staff, an ambulatory network of pharmacists, or a hybrid model that integrates staff from multiple entities.