Optimize™ Medication Therapy Management (MTM) for Star Ratings

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.

Solution Features

  • Proprietary rules engine to identify at-risk patients and prioritize outreach for CMR completion
  • Automated Targeted Medication Review (TMR) provider outreach and awareness
  • Integration of medical and pharmacy claims to identify Drug Therapy Problems (DTP)
  • J-Code specialty medications included in the medication list
  • Omnichannel (physician and pharmacy) deployment to maximize CMR completion rates
  • Data validation audit interactive reporting for regulatory compliance

Solution Benefits for Medicare Advantage Star Ratings

Improve Star Ratings

Improve Regulatory Compliance

Increase Medication Adherence

Resolve Social Determinants of Health (SDOH) Barriers

Pinpoint and Close HEDIS® Gaps

Lower Costs of Care

MTM Results

completion-time
MPL-creation
member-satisfaction

Optimize™ Comprehensive Medication Management (CMM) Solution for Commercial and Accountable Care Organization (ACO) Value-Based Medical Cost Avoidance

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.

Solution Benefits for Commercial, ACO Plans and Risk-Based Provider Entities

Proactively monitors identified DTPs with near real-time data

Robust algorithms target and prioritize high-risk patients for Comprehensive Medication Reviews (CMR)

Proactive outreach to providers through Targeted Medication Reviews (TMR) and clinician-to-clinician discussion

Targets patients with chronic conditions and multiple medications

Reduces unnecessary costs through Drug Utilization Reviews (DUR) and DTP resolution

Improves continuity of care for better health outcomes and patient satisfaction

Optimize™ to Reduce Spending for Self-Insured Employers

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.

How It Works

Prioritize

Analytics engine targets care gaps in medical claims, pharmacy claims and lab data

Group

Adhere™ Platform groups identified patients by provider to maximize the impact of each engagement

Engage

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

Solve

Providers resolve care gaps directly with their patients

Solution Benefits for Self-Insured Employers

Return on Investment (ROI)

Employers can save millions with a 4:1 ROI

Better Health

Optimize™ identifies and resolves medication adherence gaps

Targeted Outreach

100% provider-centric outreach programs available

Personalized Outreach

1 in 6 patients have existing drug therapy problems (DTP)

How We Make an Impact

Real Consumer Stories