Outsourcing MTM Programs Leads to Healthy and Highly Engaged Health Plan Members


While health plans are doing their best to improve member outcomes, low engagement levels, low adherence, and overall lack of satisfaction are still a challenge. Providing high-quality MTM programs can be expensive and while some health plans choose to manage these initiatives internally, doing so can be costly and time-consuming.

Over the last couple of decades, we’ve seen the cost of medication in the United States continue to rise. Recently, drugmakers raised the price of more than 500 prescription drugs. From the perspective of Medicare users, getting medications is becoming increasingly expensive. 

One way of keeping costs down while still driving positive member engagement is by partnering with a trusted, proven expert in clinical pharmacy services, including Medication Therapy Management, Medication Adherence, Medication Reconciliation, and more. Today, we’re going to discuss outsourcing MTM programs, how it helps health plan performance, and how it ultimately benefits health plan members. 

How Outsourcing MTM Leads to Healthier Members

Possibly the biggest benefit of MTM program outreach is how it will impact member satisfaction and health outcomes.

Beyond standard medication therapy management consultations, many members struggle to take their medication as prescribed. More than 30% stop taking them earlier than instructed. When it comes to medication adherence, around 75% of adults in the United States are non-adherent in one or more ways.  

Outsourcing to clinical pharmacists and a proven technology partner is the first step in driving medication adherence among member populations with the intent of positively impacting overall member health. 

Giving members the option to a “favorite” pharmacist and work with them – as they would any other provider – over time, will help eradicate some of the systemic issues health plans face when it comes to keeping their members healthy. Having clinical pharmacists work with patients directly, and consistently, fosters trusting relationships and better outcomes.

How Outsourcing MTM Improves Member Well-Being

Many patients have difficulty understanding and following their drug therapy regimens. The Institute of Medicine reports that over 90 million people identify with having difficulties following a drug plan. 

Health plan members need a clinical pharmacist they can trust and feel comfortable with. To this end, outsourced MTM programs should focus on increasing engagement by matching patients with pharmacists that have a relevant specialty, share common geography, and have the same native language.

In addition to their extensive knowledge and understanding of drug efficacy and potential contraindications, an experienced pharmacist acts as an advisor that provides support services and performs comprehensive medication reviews. In turn, that makes the entire relationship far more personable.  

When a patient builds a strong bond with their pharmacist, it directly improves outcomes. More than 95% of patients say that their lives and well-being have been improved because of an effective MTM program. 

Better Star Ratings, Increased Reimbursements

To show how Medicare Part D and Medicare Advantage healthcare plans perform across different categories, like member satisfaction and quality of care, the Medicare Star rating system was implemented, with scores ranging from one to five stars. 

As a result of the COVID-19 pandemic, the CMS star system rating has changed. This year’s star ratings were calculated differently than usual. In 2021, out of 400 plans rated, only 21 received a 5-star rating and 63 were rated 4.5 stars by Medicaid payers. 

By outsourcing clinical pharmacy services and improving member medication usage, health plans position themselves for Star rating improvement. Not only do higher Star ratings result in higher bonus payments, but health plans can then reallocate those funds to provide additional benefits for plan members, additionally increasing satisfaction. 

Reduce Costs Associated with MTM Programs

Relying on a trusted partner to manage MTM programs and more deliver many benefits to health plans of all sizes. Here are a few of the benefits for outsourcing versus attempting to build and run an internal MTM-focused clinical team:

  • Reduced Recruitment and Training Costs: With the help of outsourcing, you don’t have to spend time or resources attracting, recruiting, or training pharmacists. On average, it costs around $4,200 to hire a single employee. Imagine how much it would cost you to find and hire an entire team of pharmacists to stand up a year-round MTM program. 
  • Focus on Core Competency: Since so many pharmacists change professions each year, it will be harder to retain top talent without providing them with the right tools and resources needed to focus on their highly visible roles with your patients. MTM needs often ebb and flow throughout the calendar year, and unless you have enough volume to keep your pharmacists engaged, you will likely struggle with retaining them. Outsourcing will allow you to focus on the current core competencies of your team, skip the process of developing or implementing complicated technology, and entrust your quality measure improvement and Star ratings boost to a team squarely focused on delivering best-in-class results. 
  • Identify At-Risk Health Plan Members: Having staff members analyze each individual plan member record is a timely endeavor, not the mention costly. Outsourcing the MTM program will ensure that at-risk health plan members get treated first, increasing satisfaction in the process. Through the use of actionable data, your partner will be able to identify at-risk members and match them with the pharmacist first.  

Outsourcing your clinical pharmacy services to the right partner will lead to higher quality MTM results. Research from the American Pharmacists Association has shown that having a strong leader is crucial in ensuring the success of an MTM program

In Conclusion

If the members don’t trust their health plan completely, the likelihood of non-adherence rises dramatically. In the end, a well-executed MTM program yields lower costs, better patient outcomes, and greater reimbursements.

By using cutting-edge, crowd-sourcing technology, Aspen RxHealth enables health plans to leverage a large community of clinical pharmacists to deliver effective patient care. The mobile-based application matches health plan members with the most relevant pharmacists in their area, based on numerous, often overlooked factors. 

With a network of more than 7,000 pharmacists, 50 state coverage, and a less than 1% CMS requirements error rate, Aspen RxHealth allows you to outsource MTM services while ensuring the highest level of quality interventions at the lowest cost.

MTM programs aren’t the only way that Aspen RxHealth can keep your members healthier while improving your Star Ratings. Check out our latest article to learn about things you may not know a pharmacist can do.

Are you a health plan hoping to partner with a team that will help keep your members happy and healthy?
Aspen RxHealth is that team.