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Automated Review of Medication - Link to Billing, EMR, Patient & Prescriber Letters

CMR is a tool to ensure that medication use in a population is optimized. The goal of our tools is to minimize quality gaps and improve Star Ratings.

CMR may be done by pharmacists through Medication Therapy Management (MTM) for Medicare, though oftentimes application is poor and organizational star ratings may suffer.

    CMR addresses the most significant issues with Medication Therapy:
  • What is the patient’s therapeutic outcome? For example, what are blood glucose levels with current diabetes medication?
  • Are the patient’s drug therapies effective? For example, is the patient reaching HbA1c targets and are glucose levels steady?
  • Are the patient’s drug therapies safe? For example, do the patient’s kidneys function well enough to tolerate metformin?

Each month we evaluate diagnostic and medication profiles for every patient in the plan.

    Patients can be evaluated using client selection criteria such as:
  • Patient
  • Diagnosis
  • Age
  • Gender
  • Patient Severity
  • Clinical Edit Problems
  • Prescriber

Medicare patients can be reviewed for CMS selected criteria in MTM.

Patient problems can be prioritized and selected for review with accompanying reports and recommendations for each clinical edit problem.

Digital letters can be autogenerated for prescribers and patients with concerns and recommendations for change.

What is the Financial Impact?

  • In a pilot study by Iowa’s Wellmark Blue Cross and Blue Shield, the mean total care costs were about $300 less per member per month (PMPM) for patients who were monitored with CMR. Source: Modern Medicine

  • Comprehensive Medication Review at Work

    Problem: One of our clients needed a digital method for identifying patients requiring Comprehensive Medication Review (CMR) and an oversight plan to determine if the CMR was effective. They wanted the process to be available to pharmacists and physicians. They needed to include billing and payment forms. Their goal was to utilize the CMR to improve their Star Ratings.

    Methodology: We implemented a solution that had been designed, implemented and monitored in multiple states for over eight (8) years with a coalition of self-insured employers. We provided a screening tool utilizing multiple filters (e.g., diagnoses, medication therapeutic categories, age/gender, patient severity, provider specialty, etc.) to identify appropriate candidates for CMR. They also provided lists for the Medical Directors to select patients and physicians. Each patient was analyzed using a variety of clinical edits including compliance, dosage, risk of adverse drug reactions, age limitations, alternative lower cost medications, etc. Digital reports were provided that could be placed on the physician’s Electronic Medical Record (EMR), placed on the cloud, and printed as needed to hand out to patients. Digital billing forms were largely filled out to make billing more efficient, and to utilize for billing purposes.

    Outcome: he results of making these CMRs available to physicians and pharmacists with billing capabilities, resulted in expanding the outreach opportunities. This also provided a more efficient method for evaluating and reporting the results of the CMR and resulted in improved Star Ratings by 1 to 2 stars.

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    To Learn More:
    Phone:(888) 701-5438
    info@propharmaconsultants.com