Medication Therapy Management is a way for pharmacists and healthcare providers to check a patient’s medicines. They look for problems like using the same medicine twice, medicines that clash, wrong doses, not taking medicines as prescribed, or gaps between diagnosis and pharmacy fills.
Drug therapy problems can cause safety risks. They may lead to bad drug effects, hospital visits, and higher healthcare costs. For people with Medicare and Medicaid who have conditions like diabetes or high blood pressure, managing medicines well helps keep them healthy and avoid extra costs.
MTM programs find these issues early. They fix problems with actions like reviewing medicines, optimizing treatment, teaching patients, and helping them stick to their plan. These steps help patients do better and improve health plan scores, like CMS Star Ratings.
CMS Star Ratings affect how patients see plans and how much money plans get from the government. Medicare Advantage and Medicaid plans feel pressure to improve these ratings. They focus on medicine adherence, finishing reviews, and solving drug therapy problems.
Studies show that good MTM programs raise ratings by focusing on these areas. Better ratings help plans get more money and lower medical losses.
For example, a health plan in one area increased its Star Rating by 1 to 1.5 points in one year after working with an MTM tech provider. This was mostly due to better medicine-taking and focused work with members at risk.
MTM solutions use data and clinical knowledge to study patient info and find drug problems. They combine medical claims, pharmacy data, and patient details like diagnosis history and medicine refill records to find hidden risks.
They spot primary adherence gaps, when a medicine isn’t filled at all, and secondary gaps, like skipping refills or using medicines irregularly. Doctors and pharmacists then focus on patients who need the most help.
These programs include:
These steps reduce bad drug effects, manage multiple medicines well, and support preventive care.
Medicine mismanagement causes high costs in the US. It often leads to hospital readmissions and health problems that could be avoided. Reports say medicine issues cause about $528 billion in yearly healthcare spending. This is around 16.6% of all healthcare costs.
Good MTM programs close therapy gaps and help patients follow their medicine plans. This cuts risks of problems and waste. One health tech client saw a 4-to-1 return on investment from their medicine adherence services, showing big cost savings and better patient health.
Some plans using MTM platforms saw hospital stays drop by 40% and total care costs go down by over 10% within a year. This is important for Medicare and Medicaid plans that serve many patients with complex needs.
Social determinants of health are things like income, language skills, transportation, and stable housing. These affect how well patients take their medicines. Many MTM platforms use SDOH data along with medical and pharmacy info to better assess risks.
By seeing these social and behavior issues, care teams can provide better help. This might include reminders in different languages, help with medicine delivery, or enrollment in support programs for economic or social needs.
Plans focusing on these factors usually see better medicine use and higher Star Ratings because health equity is part of CMS quality measures. For example, one plan improved participation and adherence by offering outreach in Spanish, Mandarin, and Asian languages.
Technology is very important for modern MTM. It helps scale work, improve accuracy, and reduce paperwork.
AI combined with automation helps by:
By digitizing routine medicine management, hospitals and clinics can work more efficiently, reduce errors, and keep programs consistent even for large patient groups.
Some companies show how integrated MTM solutions bring success:
Healthcare administrators and IT teams are key for adopting MTM solutions. Important points include:
MTM programs work better when patients get involved. Technology that offers personal outreach and respectful communication helps patients take part in their care.
Addressing social challenges and giving timely help allows patients to understand why their medicines matter and how to use them safely. This improves medicine use, builds trust in health plans, and cuts emergency visits.
By using comprehensive Medication Therapy Management solutions, medical practices, hospital administrators, and IT teams can improve drug therapy results for people with Medicare and Medicaid. This leads to better health, fewer avoidable healthcare visits, and higher quality scores that affect plan payments and reputation.
AdhereHealth focuses on improving medication adherence by combining data targeting, clinical and behavioral science expertise, omnichannel engagement, and stakeholder coordination to enhance health outcomes, quality, and reduce costs in value-based care initiatives.
AdhereHealth leverages proprietary predictive analytics and intelligent workflow software to identify and resolve social determinants of health and behavioral barriers, delivering personalized interventions to improve medication adherence and health equity.
AdhereHealth engages members across the risk spectrum, including highest-risk and hardest-to-reach populations, partnering with managed care organizations, self-insured employers, and risk-bearing entities for government-sponsored and commercial plans.
Measures include adherence for diabetes medications (MAD), hypertension (RAS), cholesterol (Statins), medication therapy management (MTM) completion rates, statin use in diabetes (SUPD), opioid and benzodiazepine concurrent use (COB), and polypharmacy measures (Poly-ACH, Poly-CNS).
AdhereHealth integrates HEDIS and prescription data into workflows that alert clinicians on preventive care, medication use, transitions of care, and health outcomes, supporting outreach that improves quality metrics across Medicare, Medicaid, and Exchange plans.
AI-driven predictive analytics combine plan data with publicly available SDOH data daily to identify at-risk members, enabling tailored outreach and resolution strategies to improve adherence and reduce drug therapy problems.
By employing motivational interviewing, culturally and linguistically appropriate communication, and addressing SDOH barriers, AdhereHealth builds trust and empowers members, increasing engagement and improving CAHPS and HOS Star Ratings.
AdhereHealth maximizes drug therapy problem resolution, improves MTM Star Ratings performance, reduces medical costs, and uncovers additional savings through data-driven technology and a nationwide clinical team supporting pharmacists during comprehensive medication reviews.
The solution identifies numerous drug therapy problems by combining medical and pharmacy claims with predictive analytics and multimodal outreach to members, prescribers, and pharmacies, resolving primary and secondary nonadherence and optimizing medication regimens for cost savings.
Customer testimonials report improvements in CMS Star Ratings, scalability and rapid onboarding, high member satisfaction through personalized and multi-language outreach, and successful interventions resolving medication duplications, gaps, and unsafe regimens, leading to better health outcomes and cost reductions.
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