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Mtm dashboard v.1
- 1. Plan Care Manager MTM Members Total Members MTM Eligible MTM Enrollment Patient Alerts Today’s Schedule 12:00 pm Appointment with Ms. Rivera 12.30 pm Appointment with Mr. Davis 01.00 pm Appointment with Mr. Pittman 03.00 pm Appointment with Ms. Bryan Last Name First Name Member ID PBP No. Alert Type CMRPerformed STARMeasure Opp. Doull Simon ADE15895 PBP01 DUR Yes Yes Rast Jennifer XAH16845 PBP03 DDI Yes No Nicholas Don B14879656 PBP08 Non ADH Yes No Stokes Karen 146879955A PBP15 CMR Review No Yes Medwatch • Recall: FreeStyle InsuLinx Blood Glucose Meters May Show Incorrect Results • FDA Requires Lower Recommendation Doses of Simvastatin • Drug Safety Labeling Changes • Recall: Brand Name Synthroid and Levoxyl • Generic for Diovan is available now Home Patients Reports Help Contact US My Account Dashboard
- 2. Plan Pharmacist Manager MTM Members Total Members MTM Eligible MTM Enrollment Patient Alerts Today’s Schedule 12:00 pm Appointment with Ms. Rivera 12.30 pm Appointment with Mr. Davis 01.00 pm Appointment with Mr. Pittman 03.00 pm Appointment with Ms. Bryan Last Name First Name Member ID PBP No. Alert Type CMRPerformed STARMeasure Opp. Doull Simon ADE15895 PBP01 DUR Yes Yes Rast Jennifer XAH16845 PBP03 DDI Yes No Nicholas Don B14879656 PBP08 Non ADH Yes No Stokes Karen 146879955A PBP15 CMR Review No Yes Medwatch • Recall: FreeStyle InsuLinx Blood Glucose Meters May Show Incorrect Results • FDA Requires Lower Recommendation Doses of Simvastatin • Drug Safety Labeling Changes • Recall: Brand Name Synthroid and Levoxyl • Generic for Diovan is available now Home Patients Reports Help Contact US My Account Dashboard
- 3. Plan Executive Portal 67% 20% 13% MTM MEMBERS 2013 Total Members MTM Eligible MTM Enrollment Today’s Schedule 12:00 pm Appointment with Ms. Rivera 12.30 pm Appointment with Mr. Davis 01.00 pm Appointment with Mr. Pittman 03.00 pm Appointment with Ms. Bryan 0 10000 20000 30000 2011 2012 2013 2014 MTMMEMBERS MTM Plan Performance PBP01 PBP02 PBP03 0 10000000 20000000 30000000 2011 2012 2013 2014 Plan vs. Plan Financial Performance PBP01 PBP02 PBP03 Industry at a Glance • Aetna’s App Helps Users Track Themselves • Valley Preferred and Cigna start Accountable Care Program • United Healthcare New Health Benefits Store in Koreatown • U.S Unveils Health Care Web Site and Call Center • Highmark, partners announce creation of Disruptive Health Technology Institute Home Patients Reports Help Contact US My Account Dashboard
- 4. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Patient Search Results Last Name First Name Date of Birth Member ID Zip code
- 5. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization Profile • Patient Last Name • Patient First Name • Patient Address – Street, Apt/Suite, City, State, Zipcode • Patient Phone • Patient Fax • Patient Date of Birth • Patient SSN • Patient Insurance Information- along with associated family member (Insurance Company Name, Contract Number, Patient Subscriber ID, Member ID, Suffix ID, Medicare No., Group No., Policy holder’s name (Primary Applicant)) • Patient MTM Enrollment Date • Patient Allergies (Should be able to edit/add drug information). • Family History and Medical History • Patient Memo (Any additional note on patient profile) • Authorized Individuals • LTC facility information • Caregiver information • Notify RxAdvance about incorrect contact info.
- 6. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization Prescription History (Should be in a Table format) Example • Patient Last Name • Patient First Name • Patient Phone Number • Patient Date of Birth • Drug Name • Drug NDC • Drug Quantity • Refill Authorizations • Directions (How to take) • Days Supply • Physician (Provider) Information (Physician Last Name, First Name, Phone/Fax Numbers, Address, License Number- State and DEA) • Pharmacy Information (Pharmacy Name, Pharmacy NPI, Pharmacist Name, License Number, Phone/Fax Numbers) • Date of Service • Search by drug name (Should be able to see either way- Brand or Generic) • Search by time period • Ability to fax and/or print • Prescription history/record cannot be modified by user. But they should be able to add another prescription drug/OTC product separately by typing and saving it to patient profile. These additional entries should appear different than prescription record. • Alerts- DUR (Drug Utilization Review), DDI (Drug-Drug Interaction, Brand vs. Generic, Step Therapy, Med Adherence) • Pharmacist/Nurse/Case Manager should be able to see Brand vs Generic reference, Alternative drug from formulary for cost saving
- 7. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization Diagnosis (Should be in a Table Format)-Ability to add/modify all the data. • Physicals – Physician Information and Date of Examination • Lab Test Results – Lab Name, Procedure Name and Date of Test Result • Hospitals Data • Diagnosis Code (ICD 10) • Findings • Interpretations • Recommendations • Table Example: Provider Date Procedure/ Test Diagnosis Code Diagnosis Details Recommendation Notes Edit Details Dr. Jaffe xxxx Physical xxx xxx Test Suggestion, Life Style Recommnedation xxxxx Edit Updated By: 7/1/13 MR. Lint, R.Ph, RxAdvance Quest Lab xxxx Thyroid Blood Test xxx xxx xxxxxxxxxxx xxxxx Edit Updated By: 7/5/13 Mr. Anderson, Patient
- 8. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization Profile Alerts • Drug Allergy Zyrtec Zyrtec contains Carmine. This patient’s profile indicates Carmine as an allergen. Zyrtec poses the risk of causing an ingredient-based allergic reaction in this patient. • Drug-Drug Interactions ibuprofen ↔ lithium Click here for the monograph If both drugs are administered, monitor plasma lithium levels and observe the patient for signs and symptoms of lithium toxicity. Adjust the dose of lithium accordingly. • Drug-Food Interactions Lipitor+Grapefruit juice Side effects from Atorvastatin may get worse if you drink grapefruit juice. Do not take Atorvastatin with grapefruit juice • Drug-Disease Contradiction Minocycline 50 mg Patient was found to have Pregnancy on their problem list. The drug Minocycline 50 mg cap is contradicted in patients with Pregnancy
- 9. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization CMR/TMR (Should be able to fill out and print these forms in CMS defined standard formats) • Create CMR (Comprehensive Medication Review) CL ( Cover Letter) • Create MAP (Medication Action Plan) • Create PML (Patient Medication List) • Create “Summary”/”Recommendation” letter and send it along with above 3 documents. • Able to maintain log about successful and/or failed attempts to contact beneficiary • Fields for Assessment/TMR (Targeted Medication Review-by phone, face to face, or mail) Questions/Discussion Points – Should be able to type, print and provide/mail it to patient every quarter or whenever applicable. Memo should be personalized/different for patient/providers • Able to • Able to create a follow-up appointment if necessary and notify patient • Last CMR Conducted Date • Other Interventions detailed record- with patients and prescribers, also with other care givers-pharmacists, nurses • Delivery Method • Must be able to store these documents, and easily accessible by patients, other providers • Number of drug therapy problems “recommendations” made to prescribers a result of MTM services • MTM standard format guidelines for CL, MAP and PML • MTMMTM-CMS ReqMTM-Program-Standardized-Format-English-and-Spanish-Instructions-Samples-v032712.pdf
- 10. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization STAR Increase Opportunity – To be decided
- 11. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization Patient Financials • Patient Deductible Information • Patient Co-Pay Information (accumulated) • Total Drug Cost/Plan Cost (Year To Date)
- 12. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization Reporting Outcomes Measurement Recommendations made as a result of MTM services E.g. • Needs additional therapy • Unnecessary drug therapy • Dosage too high • Dosage too low • More effective drug available • Adverse drug reaction • Medication Non-Compliance/Non-Adherence) • Others (Utilization-such as recommending better time to take particular drug or avoiding with particular food) Drug therapy problem resolutions made as a result of MTM recommendations E.g. • Initiate Drug • Change Drug (such as product in different therapeutic class, dose, dosage form, quantity, or interval) • Discontinue or substitute drug (such as discontinue drug, generic substitution, therapeutic substitution, or formulary substitution) • Medication compliance/Adherence • Other (User should be able to add/edit notes to each of the above suggestions) Number of drug therapy problems “recommendations” made to prescribers a result of MTM services Number of Resolutions made as a result of MTM recommendations Other criteria specified by CMS
- 13. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Alerts CMR STAR Measures Financials Reporting Appointments Prior Authorization Appointment and Scheduling • Ability to create an appointment with this patient • Calendar • Select date, start-end time, appointment category/appointment notes
- 14. Home Patients Reports Help Contact US My Account Search Patients Search Results Last Name Member ID First Name Date of Birth Search Profile Prescription History Diagnosis Prior Authorization CMR STAR Measures Financials Reporting Appointments Prior Authorization To be decided