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

From physicians and pharmacists to health plans, it’s hard not to recognize the importance of medication therapy management (MTM) programs. However, when health plans choose to manage MTM programs internally, things can quickly become costly and time-consuming. Despite their best efforts to improve member outcomes, engagement levels, adherence propensity, and overall satisfaction, challenges still exist.

Over the last few decades, the cost of medication in the United States has continued to rise. Recently, drugmakers increased the price of more than 500 prescription drugs. For most Americans, including Medicare beneficiaries, the cost of obtaining their medications is simply becoming too expensive. 

For health plans looking to help mitigate costs and improve efficiencies and outcomes, a trusted clinical pharmacy partner can help. In fact, outsourced MTM programs can help health plans manage costs in medication therapy management, medication adherence, and medication reconciliation programs. 

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.

Despite standard MTM consultations, many members struggle to take their medications as prescribed. More than 30% stop taking them earlier than instructed. In fact, around 75% of adults in the United States struggle with medication adherence in one or more ways.  

For health plans intending to positively impact member health, outsourcing MTM to a proven partner is the first step. The most effective partners leverage the power of clinical pharmacists to educate and engage members during personalized consultations. We know that member education is key to improving medication adherence, and pharmacist-led consultations are the perfect vehicle for it.

Giving members the option to work with a pharmacist over time helps eradicate some of the systemic issues health plans face in keeping their members healthy. Having clinical pharmacists work with members directly and consistently, fosters trusting relationships and better outcomes. Stronger relationships between pharmacists and their patients have also been shown to improve education and lead to better medication adherence.

How outsourcing MTM improves member well-being

Many people 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 treatment plan. That’s just one reason medication non adherence rates are so high.

To help improve outcomes and medication adherence, 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 members with MTM pharmacists that have a relevant specialty, share common geography, and have the same native language.

Beyond their extensive knowledge of drug efficacy and contraindications, experienced MTM pharmacists are advisors who provide ongoing support and education. This approach leads to strong relationships and improved member health. 

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

Better Star Ratings, increased reimbursements

Member satisfaction and quality of care are important factors in the Medicare Star Rating system. It was implemented to show how Medicare Part D and Medicare Advantage health plans perform across different categories.

As a result of the COVID-19 pandemic, the CMS star system rating has changed. Recent Star Ratings were calculated differently than usual. In 2021, out of 400 plans rated, only 21 received a 5-star rating and 63 achieved 4.5 stars.

While Star Ratings are based upon numerous criteria, some of the most impactful efforts are those in the clinical pharmacy space. Medication adherence directly influences several Star Measures that are intended to gauge health plans’ management of medications in their chronically ill members. By outsourcing clinical pharmacy services and improving member medication adherence, health plans position themselves for Star Rating improvement. Not only do higher Star Ratings result in higher bonus payments from CMS, 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 clinical pharmacy programs delivers many benefits to health plans of all sizes. Here are a few of the benefits of outsourcing versus operating an in-house MTM pharmacy team:

  • Reduced recruitment and training costs: With the help of outsourcing, you don’t need to spend time or resources attracting, recruiting, or training clinical pharmacists. On average, it costs around $4,200 to hire a single employee. Imagine the cost to hire, train, and retain an entire team of MTM pharmacists to stand up a year-round program – a program in which your volume may ebb and flow throughout the year. 
  • 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 members. MTM program needs often ebb and flow throughout the calendar year, and unless you have enough volume to keep your pharmacists engaged, you will likely struggle to retain them. Outsourcing allows 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 to 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. Outsourced clinical pharmacy programs still allow for strong relationships between health plan members and pharmacists through intelligent matching technology. 

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

How Aspen RxHealth’s MTM program can help 

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

Aspen RxHealth’s cutting-edge platform enables health plans to leverage the largest community of remote MTM pharmacists to deliver effective care. The platform matches health plan members with the most relevant pharmacists in their area for telephonic care delivery, based on numerous, often overlooked clinical and social factors.

With a network of more than 7,000 pharmacists and 50 state coverage, 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 this article to learn about things you may not know a pharmacist can do.

If you’re a health plan searching for a team to help you keep your members healthy and happy, it’s time to consider Aspen RxHealth.

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