Outcomes MTM System

The Outcomes MTM System covers a broad menu of services to improve health care quality and control costs, including:

• Medication Check-Ups
• Prescriber Consultations
• Patient Compliance Consultations
• Patient Education & Monitoring
• OTC Consultation

Our system features bi-directional claims traffic that feeds plan initiated services to pharmacies (see TIPs™) while still leveraging the drug therapy expertise, patient-specific information and consumer access afforded by the Personal Pharmacist network.

TIP stands for Targeted Intervention Program. The Outcomes MTM System analyzes prescription claims data from contracted plans to "push" targeted interventions or "TIPs" to the plans' pharmacy networks.

TIPs focus on such areas as:

• Formulary/preferred drug list interventions
• Drug interactions
• Compliance and persistency
• Inappropriate medications in the elderly
• Therapeutic duplication
• HEDIS/NCQA guideline recommended treatments

New TIPs are introduced on a continual basis and may be customized to meet the specific needs of a client or patient population.

The Outcomes Personal Pharmacist network is the only national network devoted exclusively to the delivery of face-to-face MTM services by local independent, chain, consultant and health system pharmacists.

• All network pharmacists complete specific training on delivery and documentation of MTM services in the Outcomes System. 
• Members may obtain MTM services from any of the 10,000+ Personal Pharmacists nationwide.

New providers are added to the Personal Pharmacist network on a continual basis. Outcomes has proven techniques to target and expand network coverage in specific geographic areas.

The Outcomes Personal Pharmacist Training Program is required for all participating pharmacists. This instructional course on the delivery, documentation, billing and administration of MTM services using the Outcomes MTM System is available online and/or via interactive CD-ROM. It is also offered to groups in a live presentation format.

Broken into modules, the training program allows pharmacists to work at their own pace. Once training is completed, pharmacists are equipped with the information they need to get started in the Outcomes MTM System.

Outcomes offers an electronic charting platform to facilitate the documentation, billing and administration of MTM services to members. Features of this platform include:

• Secure transactions
• HIPAA-compliance
• Web-based convenience

Outcomes published its initial MTM web platform in 1999—the first of its kind. Since then the platform has evolved into a full-service electronic charting system. The system includes an MTM Profile report which may be printed and provided to a member and/or their physician(s) to further bridge communication.

Our user-friendly platform was created and developed based on feedback from thousands of providers and clients and is the premier MTM platform in the industry. The platform is available free-of-charge to all Personal Pharmacists to assist in the provision of MTM services to members.

Outcomes offers unsurpassed experience in MTM program administration. Our knowledgeable staff assists Personal Pharmacists with MTM implementation and troubleshooting through on-site, telephonic and online support.

Outcomes publishes a series of e-newsletters called MTM Snapshots. Each MTM Snapshot contains information designed to help Personal Pharmacists improve their delivery of MTM services. High-performing providers and exemplary cases are highlighted. An additional e-publication, Personal Pharmacist Update, is distributed monthly to provide Personal Pharmacists with the latest news on the Outcomes MTM System.

Supervisory personnel may obtain administrator access to the Outcomes MTM System to monitor activity and engage quality improvement procedures of pharmacy- and pharmacist-specific MTM performance. These features are available to all participating MTM Centers free-of-charge.

Outcomes delivers an industry-leading, two-step quality assurance process to ensure consistent and reliable MTM services across the Personal Pharmacist network.

• Step I is woven into the Outcomes electronic charting platform in the form of drop-down menus, split screens and online help options.
• In Step II, clinical experts manually review MTM service claims for quality and completeness. The Electronic Charting Platform enables two-way communication between these reviewers and Personal Pharmacists.

Outcomes has also established formal relationships with multiple CMS-approved Quality Improvement Organization (QIOs) to identify and develop MTM best practice techniques.

Robust data collection with Outcomes' electronic charting platform allows for comprehensive reporting of MTM activity. Our platform's pre-programmed logic simplifies documentation while generating clean and consistent claims data. Available real-time reports feature:

• Cost avoidance modeling
• Breakdown of intervention types
• Provider report card scores
• Full transaction detail

Analysis of the MTM claims database allows Outcomes to work with contracted plans to calculate return-on-investment while qualitatively describing the member experience.

Outcomes serves as a transparent fiscal intermediary between sponsors and participating MTM Centers. Pharmacy payments occur on a 30-day cycle and are directed to the contracted entity (pharmacy/company). Payments may be tracked electronically by pharmacy and pharmacist.

Participating MTM Centers may follow the payment status of each MTM service claim at any given time as it is processed through the documentation, billing and quality assurance process.