Comprehensive Medication Review: Connecting Patients, Payers, and Pharmacists

6 min read
Comprehensive Medication Review: Connecting Patients, Payers, and Pharmacists

Medication-related problems are a major issue in the United States - one that comes with significant cost for patients and health plans covering their care. According to the American Pharmacists Association, it's estimated that up to 1.5 million adverse drug events occur annually and account for $177 billion in injury and death. Many of these costly events are preventable when patients are well-informed and expert providers intervene early. For patients on complex regimens, a Comprehensive Medication Review (CMR) can lead to improved medication outcomes, decreased hospitalizations, and lower healthcare costs for both patients and payers. This review is one of a wide range of medication therapy management (MTM) services that can optimize health outcomes for patients of any age. 

The Comprehensive Medication Review process 

The Medicare Modernization Act of 2003 requires that all Medicare Part D insurers provide MTM services to selected beneficiaries in order to enhance their medication therapies and detect any medication-related problems. An annual CMR performed by a qualified provider (typically a pharmacist) is a necessary element of these MTM services. The process is fairly simple and has been proven to help enhance better patient outcomes and drive down costs. 

During a CMR, the patient's full health history is obtained through a patient portal, along with a complete list of the medications and over-the-counter (OTC) products they are actively taking — including herbal and nutritional supplements. The information collected is assessed for any conflicts, duplications or potential drug interactions. The pharmacist discusses the medication regimen with the patient — noting proper use and breaking down any adherence barriers or gaps in care — and any potential cost-effective alternatives that could replace more expensive medications. 

Any issues uncovered from the CMR — such as side effects or underlying medical problems — are added to an actionable list for the pharmacist and patient to resolve together by adjusting, adding or removing medications. The pharmacist also collaborates with the patient's doctor to discuss potential changes to their medication regimen and address any gaps in care. However, it is ultimately the patient's decision to accept these changes or not. This one-on-one time is incredibly important to support the patient in their healthcare journey. 

The value of CMRs 

Community Health Group (CHG) conducted a recent analysis of Medicare MTM programs with Outcomes® that highlights the advantages of working with Outcomes to implement CMRs for both patients and payers. When CHG completed an assessment of their MTM program for members of their Medicare population, they found that CMRs led to a reduction in medical expenses of $4,000 per patient per year. 

Patients in this analysis fit criteria similar to MTM program eligibility criteria for most Medicare plans. Members must: 

  • Have three or more of the selected chronic diseases 
  • Take at least eight covered Part D medications 
  • Incur one-fourth of the annual cost thresholds ($4044) for covered Part D drugs in the previous three months 

CHG discovered that the members who received a CMR through the Outcomes platform averaged a 5% decrease in total cost of care in comparison to members who did not receive CMR. Furthermore, these patients spent less time in the hospital, had decreased cost of overall healthcare and had better adherence rates. When patients benefit, the entire system benefits. 

CHG took their research another step further with a multi-year analysis of a CMR program to assess the value of it in the long term. By year two, that cost differential grew to 16.7%, providing evidence of a year-over-year increase of financial savings and improved health outcomes. 

How Outcomes is revolutionizing CMR solutions 

Outcomes not only makes conducting a Comprehensive Medication Review easier than ever with a user-friendly, streamlined process, but the platform enhances patient care through supportive services such as patient adherence consultations, post-hospitalization medication reconciliation, prescriber consultations, and condition management. They also work with health plans to develop new targeted interventions to meet specific patient needs. 

Additionally, the Outcomes multi-channel delivery network enhances the service patients receive by facilitating pharmacists to "meet them where they are." This cutting-edge system ensures the pharmacist can serve the right patient at the right time with the right mode of delivery, regardless of the patient's setting. Whether they be in a retail pharmacy, hospital, clinic, or in their own home, this patient-centered strategy helps to reduce potential barriers they may face in accessing important healthcare services. 

If you're interested in offering CMR services but don't know where to start, the Essential solution offered by Outcomes can help you target Medicare members who will benefit most. With Targeted Medication Reviews (TMR), pharmacists and payers can identify who the most at-risk members are — those with chronic illnesses, for example — and evaluate where there are gaps in their care. 

Payers should invest in services that leverage the relationship between pharmacists and their patients. The Comprehensive Medication Review and other MTM services offered through Outcomes not only result in significant improvements in a patient's health and wellbeing, but they also have the potential to dramatically decrease the financial burden for both the patient and the entire healthcare system that results from costly medication-related issues. 

Find out how Outcomes is delivering successful MTM programs and helping pharmacists change lives. 


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