OptimizeMTM™ is AdhereHealth’s performance-based Medication Therapy Management (MTM) solution. By combining data-driven technology and clinical insights, AdhereHealth can tailor OptimizeMTM™ to meet each partner’s specific needs and program submission criteria.
From MTM eligibility qualification/offer through data validation, the solution harnesses AdhereHealth’s SaaS-based P3Link™ platform to efficiently manage clinical workflows and regulatory reporting requirements, allowing clinicians to focus on consumer health and wellness – not administrative tasks.
Integrated with AdhereHealth’s Pharmacy at Home™offering, consumers benefit from real-time medication synchronization after the counseling. Pharmacy at Home™ includes interfaces with national pharmacy solution partners to deliver medications to the consumer’s home. The program includes AdhereHealth’s pharmacy, AdhereRx™, which provides hand-delivered pharmacy right to the home for high-acuity consumers who benefit from ongoing medication counseling for polypharmacy management.
Performance
- CMR conversion full-risk pricing model aligns goals and objectives
- Tech-enabled workflow empower higher CMR completion ratio
- Transparent ROI, resolving Drug Therapy Problem (DTP) resolution actuarial validation, provides for improved healthcare outcomes and financial return
Scalability
- SaaS-enabled deployment across internal health plan clinical teams and/or provider network
- Sophisticated analytics ingests multiple data sources to provide for a more comprehensive consumer profile
- Rules-based analytics aggregate client data (e.g., pharmacy, eligibility, medical) which is fully integrated into the patient record
- Unlimited capacity to support multi-tiered clinical resources
Compliance
- Automated Medication-related Action Plan (MAP) and Personal Medication List (PML ) creation
- 100% data validation and Health Plan Management System (HPMS)
- Supports MTM mock audit and program criteria changes
Benefits
Data Analysis
Real-time clinical analysis, eligibility data, medical claims, pharmacy claims, OTCs, supplements and consumer reported medications
Call Queue Scheduling
First-in and first-out call queuing, CMR scheduling, detailed user-level reporting
Rules Engine
Adherence monitoring, at-risk stratification and evaluation
Fulfillment & Compliance
Automated MAP/PML creation, mitigate data validation risk
Higher Quality Scores
Data-driven MTM reduces gaps leading to better performance
MTM Results
How We Make an Impact
Real Consumer Stories
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Data-Driven Tools
Stratify™
Stratify™ predictive analytics identify medication adherence and care assessment gaps using comparative benchmarks that support targeted consumer and provider engagement.
Quantify™
Quantify™ builds actionable client-specific scenario modeling for value-based care incentive structures and incorporates Stratify™ analytics to achieve targeted outcomes.
P3Link™
P3Link™ is a regulatory compliant clinical workflow for Medication Therapy Management (MTM) that uses Stratify™ analytics to guide interventions.
QiLink™
QiLink™ is a clinical workflow using decision support to guide gap closure for clinical and non-clinical interventions with consumers and providers using Stratify™ analytics.
Discern™
Discern™ is a business analytics solution that provides real-time client data visualization of outcomes and program performance.