Is it time to bring your MTM program inhouse?

More and more we hear plans are concerned their MTM programs consume significant resources but do not produce requisite value. Some common complaints we have heard include:

  • My MTM program is just "a CMR generation machine"… I can't tell if CMRs actually help to reduce therapy gaps.
  • There are so many pharmacists doing CMRs for my plan… I am concerned about clinician consistency.
  • I have a hard time getting my MTM vendor to work on STAR measures outside of the traditional MTM program…I want to have one of my plan pharmacists work on post-discharge medication reconciliation.

Inhousing your MTM program can save health plans create significant savings, optimize internal clinical resources and drive STAR improvements. To be clear, inhousing an MTM program is a massive undertaking. The basic Part D MTM program has become very proscribed and subject to validation and audit. CSS has developed a proven program to help health plans to bring their MTM program in-house, and we wanted to share a few essential capabilities when selecting an MTM platform.  

 

Essential Capabilities of a High Performing MTM Platform:

 

Audit Hardening: Plans looking to in-house their MTM programs need to assure that they will be able to operate a CMS compliant Part D MTM program. CMS audits have been put on hiatus, but they will be back, and you should be ready to document your Part D MTM process and CMRs in a way that stands up to audit.

Flexibility: The platform you select should allow you to be "fast-to-market" with new medication management initiatives. If your plan identifies that the Part C measure - Osteoporosis Management in Women who had a Fracture - is an issue, your software should allow you to configure and have a medication management effort in place within 30 days. Affecting quality measures within a program year requires a quick response.

Scalability: Medication management software should eliminate the "clinical administrative" work from the medication management process. Your clinicians are a finite and valuable resource. They should be using their valuable clinical expertise to coach members to better adherence, not type the same recommendation over and over. Medication management software should automate rote MTM functions.

Population Health Analytics and Insights: Drug therapy utilization patterns are dynamic. Once you expand your medication management efforts outside of Part D MTM you will always need to be "looking for the next thing." What is the next cost inefficiency, patient safety, adherence issue to be addressed? This will require that your medication management software can provide you with the clinical analytics you need to understand what the next therapy gap target will bring value to your plan.

Implementation: Moving from an outsourced MTM vendor to an in-house program will be a complex process. You will need to develop procedures, as well as hire and train clinicians. If you want to do this seamlessly and without consternation you will need support for the transition. Support that will help to show you best practices for achieving the "block and tackle" of MTM. Support for onboarding new clinicians. Support for designing and operationalizing novel non-Part D medication management efforts.

Clinical Support: Everybody needs a "Plan B". Engaging a Plan B is not a mark of failure, it is a demonstration of excellent planning. As you are assuming the responsibility for in-housing your MTM program, you should have a Plan B for clinical services in place to support your new staff through the rough spots that you are almost guaranteed to encounter.

 

As always I am happy to discuss these topics so don't hesitate to email jnotaro@csshealth.com  or call me at 716.200.4865.

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