Purpose:
** To optimize therapeutic outcomes for individual patients.
** Optimize drug therapies.
** Improve medication use.
** Reduce risk of adverse events and drug interactions.
** Increase patient adherence and compliance with prescription drugs.
** Identify interventions that provide improved care to members.
** Interventions should result in health benefits for the Members and cost effective for the Members and CarePlus.
Medicare Required Criteria for MTM Eligibility:
** Beneficiary must have multiple chronic diseases.
** Beneficiary must have filled multiple covered Part D drugs.
** Beneficiary must be likely to incur annual cost of more than $3,000 all covered Part D drugs.
CarePlus MTM Eligibility:
** Member must be diagnosed with 3 or more core chronic disease conditions.
** Members with 8 or more unique Part D Medications.
** Have anticipated cost of medications above a predetermined dollar amount ($3,000 per year for 2012) (Ex. If a Member spends more than $1,000 in a quarter, it can be assumed they will spend at least $3,000 in a year.)
Examples of Core Chronic Conditions:
** Chronic Heart Failure
** Diabetics Mellitus
** Dyslipidemia
** Hypertension
CarePlus MTM Program Design:
The CarePlus MTM will notify the beneficiary of the Comprehensive Medication Review (CMR) opportunity through MTM messaging in the Smart SummaryRx statements once determined eligible for the MTM program. The phone number to the Member Services call center will be provided so the member can schedule their CMR.
MTM consultations will allow a beneficiary to speak with a clinical advisor (Pharmacist, Registered Nurse) about their CMR and / or any identified drug related problems. The clinical advisor will then work through the targeted interventions by consulting with beneficiaries and serving as their advocates in contacting prescribers, as necessary, to resolve drug therapy problems.
CarePlus will perform targeted medication reviews at least quarterly to assess medication use and determine if a follow up intervention is warranted for the beneficiary and / or prescriber. CarePlus will reach out to the beneficiary and / or prescriber via one of the following ways: Telephonic, Face to face, Mail or Fax.
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