Optimize™ MTM is AdhereHealth’s comprehensive medication management solution for Medicare Advantage Star Ratings Comprehensive Medication Review (CMR) completion. Offered as a software-as-a-service (SaaS) model for providers and retail community pharmacies or technology-enabled services via AdhereHealth’s nationwide clinical team, Optimize MTM can increase Star Ratings and ensure regulatory compliance with CMS, allowing clinicians to focus on member health and wellness – not administrative tasks.
Optimize MTM proactively monitors eligibility data, medical claims and pharmacy claims to identify MTM eligible patients. By combining data-driven technology and clinical insights, the solution is tailored to meet your specific needs and program submission criteria.
Integrated with AdhereHealth Pharmacy Services, members benefit from real-time medication synchronization after counseling. Our pharmacy solutions include interfaces with national pharmacy solution partners to deliver medications directly to the patient’s home. The program includes AdhereHealth’s digital pharmacy, AdhereRx™, which provides contact-free private courier pharmacy right to the patient’s home for those who benefit from ongoing medication counseling for polypharmacy management.
Available as a software-as-a-service (SaaS) or technology-enabled service using AdhereHealth’s nationwide clinical network, Optimize CMM uses predictive analytics and omni-channel patient/provider outreach to decrease avoidable medical spend through utilization and specialty pharmacy costs. Using pharmacy claims, medical claims and eligibility data sets, Optimize CMM identifies and addresses Drug Therapy Problems (DTP) that result in medical loss ratio (MLR) improvement. The solution reviews all medications in a holistic patient profile – prescription, nonprescription, alternative, traditional, supplements, vitamins, samples – with each at-risk patient to improve health, address potential issues and increase continuity of care.
By proactively engaging with patients to manage adherence and pharmacy needs, AdhereHealth can provide a significant return on investment (ROI) for health plans while improving clinical quality and patient experience.
Optimize™ for Self-Insured Employers is a proactive intelligent clinical workflow that enables employers to guide highly specific patient interventions and provider engagement. Using dozens of data sources, the solution helps reduce unnecessary medical costs related to drug therapy problems (DTP). This solution is powered by Adhere™ Platform analytics that integrate real-time input with national benchmark data and our analytics-guided clinical decision support software. This advanced data-driven solution has more than a decade of quantifiable outcomes bolstered by fully guaranteed program performance.
Analytics engine targets care gaps in medical claims, pharmacy claims and lab data
Adhere™ Platform groups identified patients by provider to maximize the impact of each engagement
Each provider's office receives a list of their identified patient's care gaps via system-generated fax and our clinical team follows up with provider via phone to discuss care gaps and suggest resolutions
Providers resolve care gaps directly with their patients
Karen was taking two antidepressants and during a CMR, AdhereHealth’s analytics alerted our pharmacist to a potentially dangerous medication duplication. Our pharmacist discussed the issue with Karen and subsequently the consumer addressed the issue with her doctor. The doctor modified her regimen thus improving her overall care plan.
Margaret’s chronic asthma benefits from a rescue inhaler for flare-ups. AdhereHealth's analytics showed a prescription gap and during AdhereHealth’s CMR discussion, our pharmacist discussed the issue with Margaret, prompting outreach to her doctor for an order to prevent asthma emergencies.
Roberta is 67 and her muscle pain was being treated with methocarbamol, which increases the risk of falling for consumers over 65 or older. AdhereHealth analytics identified tizanidine as a safer alternative, alerting our nurse to discuss the gap with Roberta’s clinician prompting a medication change.
Ida R. has type 2 diabetes and misunderstood how her insulin would regulate glucose release during the early dawn hours. AdhereHealth analytics identified insulin fill gaps that increased Ida's risk of complications and future hospitalizations. Upon our clinician intervening, Ida was educated about the importance of insulin and diabetes educational support. Ida returned to her prescribed care plan, improving her quality of care.
Stephen was prescribed lisinopril for high blood pressure but missed doses increasing risk for cardiac arrest. AdhereHealth’s analytics identified the risk and upon our clinician’s discussion with Stephen about his apparent memory issues, a pill organizer was facilitated ultimately improving adherence.
Keith is in a long-term care center and was taking blood thinners warfarin and dabigatran as part of his daily regimen. AdhereHealth immediately contacted Keith's provider about the oversight. The provider agreed to discontinue one of the blood thinners. AdhereHealth's OptimizeMTM™ platform caught the therapy duplication preventing severe bleeding and other potentially life-threatening complications for this consumer.
Ed has type 2 diabetes and is at risk for heart disease and/or stroke. AdhereHealth’s analytics identified a gap in statin usage for his diabetes and this prompted our nurse to reach out to Ed’s doctor. The doctor prescribed lovastatin to Ed and it addressed the quality issue.
Mrs. Robbins’s heart disease requires simvastatin and clopidogrel to reduce heart attack and stroke risk. AdhereHealth's medication adherence analytics prompted our pharmacist to discuss these risks. Mrs. Robbins supported the plan, improving quality and reducing her risk of hospitalization.
Wanda is on 13 medications to support her multiple health conditions. The AdhereRx™ program helped Wanda synchronize her medication refills and couriered to her home monthly. Our pharmacist also helped Ms. Jones order a blood pressure cuff to monitor her blood pressure.
David’s cholesterol medication refill was months overdue and during AdhereHealth’s CMR, he stated the discontinuation was due to receiving positive lab results. Our pharmacist convinced David the good lab results were a result of the medications, addressed the serious health risks with him and the consumer immediately refilled the medications.
Carla struggled with high blood pressure and her losartan prescription was out of refills. AdhereHealth’s pharmacist reached out to Carla due to medication adherence analytics identifying medication gaps and subsequently contacted the physician for the refill order and improved quality of care.
Julie was taking a high-dosage of morphine for pain, but due to side-effects her physician changed medications to hydrocodone, oxycodone and acetaminophen. AdhereHealth analytics identified a acetaminophen dosage guideline issue, prompting our pharmacist to contact Julie’s physician to discuss alternatives and ultimately improved the chronic pain management.
Greg’s hospital discharge plan included new medications to treat his cholesterol. AdhereHealth’s analytics identified a high statin dosage and upon a discussion with our pharmacist, it became clear Greg was taking two statins prescribed by two physicians. Greg met with his doctor to resolve the error.
Josh’s medication was changed from lisinopril to losartan for his hypertension. AdhereHealth analytics identified Josh hadn’t filled the lostaran which increased risk for stroke. Our clinician contacted Josh who was confused and followed up with his pharmacist and physician to close the gap.