Medication Therapy Management (MTM) Solution

Transcription

1 Medication Therapy Management (MTM) Solution Service Overview Updated Congratulations on your decision to partner with Cardinal Health to help ensure that your patients receive beneficial Medication Therapy Management (MTM) services. Cardinal Health MTM Solution is committed to advancing the community pharmacy s ability to deliver important MTM services to patients. Our MTM Solution pharmacists complete the MTM services on your behalf, allowing your staff more time to focus on providing in-store patient care. Providing MTM services to your patients not only adds value to your store, but also helps you deliver a deeper level of customer care that can improve outcomes and increase medication adherence. Our goal is to partner with you so that your patients view your pharmacy as a critical part of their healthcare team. This Service Overview packet provides essential information to implement the MTM Solution into your pharmacy, including: Setting up your MTM Solution service o What to expect as you get started o Best practices and next steps for your pharmacy MTM documents your pharmacy will use The MTM Solution team is here to help you ensure a seamless implementation. We are available to offer support and resources throughout the implementation process and for the duration of our services. For assistance, please contact your Cardinal Health sales representative, us at MTM@cardinalhealth.com or visit our website at cardinalhealth.com/mtm. Once again, congratulations on your decision to provide MTM services to your patients, and welcome to the program! Sincerely, Cardinal Health MTM Solution team

2 Setting up your MTM Solution service Our team is now available to complete, on your store s behalf, Targeted Medication Reviews (TMRs) and Comprehensive Medication Reviews (CMRs) for certain health plans, as assigned by certain MTM vendor platforms. We encourage you to complete as many MTM opportunities as possible that are outside of our eligible offering. We have prepared an Onboarding Process Overview for each of our MTM Vendors. Getting Started Cardinal Health will submit your signed contract for the Cardinal Health MTM Solution to the MTM Vendors. Activating the contract for service may take several weeks, depending on the MTM Vendor. Your pharmacy will receive a call from an MTM Solution team member once your pharmacy is set up for service. As new MTM Vendors are added, you do not need to sign a new agreement with Cardinal Health; your pharmacy will be enrolled automatically for services with any new MTM Vendor. What to Expect Pharmacy Periodic calls from MTM Solution team members for patient and physician contact information, as well as outcomes of patient and/or prescriber recommendations Faxed copies of any patient documents, such as the Medication Action Plan (MAP) and Personal Medication List (PML), and prescriber recommendation letters. MTM Solution team members reaching out to your pharmacy for patients: o Who cannot be reached after three phone contact attempts o Who have no valid phone number o Who need to be notified of service opportunities Patient Services vary by health plan and patient eligibility. MTM-eligible patients may receive a: o Comprehensive review of the patient s allergies, medical conditions and medications in order to assess any medicationrelated problems o Targeted review to assess a specific medication-related problem MTM Solution pharmacists will make at least three contact attempts. o Calls come from the toll-free MTM Solution telephone number, o Incoming calls will have the name Cardinal Health appear on the caller ID. o The patient may see a 614 area code on the caller ID. Next Steps and Best Practices Our MTM Solution services are most successful when we work together with you as a team. Your pharmacy team can improve successful delivery of MTM opportunities by: Informing every member of your pharmacy staff about MTM Solution, including: o Your contract with Cardinal Health MTM Solution to provide MTM services to your eligible patients o The name of your assigned MTM Solution pharmacist o Expectations of requests for patient contact information o Receipt of faxed copies of MAPs, PMLs and prescriber recommendation letters Logging into MTM platforms once a week to monitor MTM services and opportunities Notifying eligible patients to expect a phone call from an MTM Solution pharmacist who will review their medications for effectiveness, side effects and potential cost savings o Consider utilizing MTM Solution bag stuffers to encourage your eligible patients to call us for an appointment; bag stuffers are available through your assigned MTM Solution pharmacist Reviewing the MAP, PML, and prescriber recommendation letter provided by the Cardinal Health MTM Solution pharmacist and following up with your patients and their providers as appropriate We greatly value the trust placed in us from our retail pharmacy customers, and appreciate being part of your pharmacy s patient care team. At any time, if you have any questions, you can always reach out to us by: Phone: (toll-free) MTM@cardinalhealth.com

3 Comprehensive Medication Review (CMR) By completing Comprehensive Medication Reviews (CMR) in your pharmacy, you can realize several benefits: Increased store traffic Improved quality of relationships with your patients Increased prescription revenue Meet important medication adherence measures that affect CMS Star Ratings Generally, patients who receive a Medication Action Plan (MAP) and Personal Medication List (PML) from your pharmacy are more likely to return for future refills. Medication Action Plan (MAP) and Personal Medication List (PML) Overview The Centers for Medicare and Medicaid Services (CMS) require that the patient receives a standardized takeaway document, including a MAP and PML, within 14 days of the service. Cardinal Health MTM Solution will mail these documents to your patients and send copies to your pharmacy via fax. Medication Action Plan (MAP) Completed by the MTM Solution pharmacist, the MAP describes each concern discussed and how the patient can follow up on actionable items to resolve medication-related problems and improve his/her overall health outcomes. The MAP starts with instructions for the patient on how to use it. The MAP will contain an average of 3-5 actionable items in order of priority. The pharmacist fills out the What we talked about section and What I need to do section. The patient fills out the What I did and when I did it section. Personal Medication List (PML) The PML is an updated list of all the patient s prescription and non-prescription medications. The patient is encouraged to share this list with his/her health care providers and to update it as needed. The PML: Includes each medication discussed during the review along with the appropriate indication, directions and prescriber Contains instructions to the patient on how they can use and update the medication list

4 How to Execute a MAP and Review a PML After receiving the Patient Takeaway via fax, review the MTM Solution pharmacist s recommendations within the MAP as well as the medications listed in the PML. Update your patient s medication profile as needed in the pharmacy management system. Follow up with your patient so you may assist with: o Adherence issues by offering programs and products, such as medication synchronization, automatic refills, delivery service, pillboxes, daily medication packaging and monthly pill card packaging o Immunizations recommended on the MAP o Durable Medical Equipment (DME) and testing supplies o Blood pressure readings for patients who do not self-monitor or do not know their blood pressure and goals o Other point-of-care testing, such as glucose readings, A1c tests, cholesterol screening and PT/INR measurements o Smoking cessation programs and/or nicotine replacement products o Weight loss products and/or physical activity programs, such as a weekly walking club starting from your pharmacy Prescriber Recommendation Letter Your MTM Solution pharmacist will send any interventions and/or recommendations to the prescriber in a prescriber recommendation letter; letter formats vary by MTM platform. The prescriber recommendation letter will instruct the prescriber to contact your pharmacy regarding any medication changes or additions. Your pharmacy will receive a faxed copy of the prescriber recommendation letter. Review the prescriber recommendation letter and follow up with the patient s provider regarding any medication recommendations, as appropriate.

5 Medication Therapy Management (MTM) Solution OutcomesMTM Overview Updated: Cardinal Health MTM Solution is available to complete telephonic MTM opportunities on your store s behalf. Opportunities include Targeted Medication Reviews, known as TIPs, as well as Comprehensive Medication Reviews (CMRs) approved for telephonic delivery. These CMRs and TIPs are assigned through the OutcomesMTM platform and are displayed in your MTM Opportunities queue. We will attempt to complete all of your eligible telephonic TIPs and telephonic CMRs. As we work on these MTM opportunities, you may view notes on the To Do tab of the patient profile indicating the date and the name of the pharmacist who contacted your patient. Additionally, our team documents contact attempts and important information for telephonic CMR patients in Section 7 of the CMR & Action Plan tab. Any CMRs or TIPs outside of our eligible offering may be completed by you or your staff; in fact, we encourage you to complete as many opportunities as you are able. To determine if a face-to-face consultation is required for CMR delivery, select a patient from the MTM Opportunities queue to open the patient profile, and go to Section 8 on the CMR & Action Plan tab. If there is a message next to the phone delivery option that states a prior authorization code is required, the CMR must be delivered through a face-to-face consultation or through a telehealth consultation, which involves the use of secure video technology. Copyright 2016, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks

6 Onboarding Process Cardinal Health will submit your signed contract for the Cardinal Health MTM Solution services to OutcomesMTM. Activating the contract for service with OutcomesMTM may take two to four weeks. Having an OutcomesMTM login is not required; however, it is strongly recommended so you may view MTM opportunities and MTM claims completed for your patients. Additionally, having an OutcomesMTM user account will enable you to deliver face-to-face opportunities that are not provided in our current service offering. Pharmacies without OutcomesMTM access should: o Visit o Click Create an Account under the Log In button to create a unique user ID and password. o Complete the training and take the quiz. o Provide your pharmacy information and NCPDP to gain access to the platform. For account setup assistance, contact your Cardinal Health sales representative or call OutcomesMTM Provider Resources at What to Expect A Cardinal Health MTM Solution team member will call your pharmacy to confirm your enrollment once your pharmacy is active in the OutcomesMTM platform under the Cardinal Health MTM Solution group. An MTM Solution staff member may also contact your pharmacy to follow up on patient and/or prescriber recommendations. Your pharmacy can expect a higher completion rate when your pharmacy staff notifies your eligible patients to expect a call from a Cardinal Health MTM Solution team member. Our team will introduce themselves to your patients as a pharmacist or pharmacy technician with Cardinal Health calling on behalf of your pharmacy. View your MTM-eligible patients by logging into the OutcomesMTM platform and clicking on the MTM Opportunities tab. Billing and Payment The payment process for completed MTM services: MTM Solution pharmacists complete MTM services. OutcomesMTM distributes payment via check to your pharmacy for all services conducted on your pharmacy's behalf by the Cardinal Health MTM Solution team. Cardinal Health bills your pharmacy on your Cardinal Health invoice only for services completed by the MTM Solution team on your pharmacy's behalf (minimum of two months in arrears to ensure the pharmacy has already received payment). o The item description on the invoice will display as OutcomesMTM Consultation along with the consultation amount and number of those consultations completed at that price point (see attached example). The pharmacy pays Cardinal Health directly for the services completed on your pharmacy's behalf. Reporting To reconcile billing statements for completed services: Log into your OutcomesMTM account. Click on the MTM Claims tab. Select the date range you wish to view in the Date Range box. Select Approved and Paid in the Claim Status box.

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