As part of the Centers for Medicare and Medicaid (CMS) requirements for Medicare Part D, health care plans are required to provide Medication Therapy Management (MTM) programs. MTM programs are designed for Part D beneficiaries who meet certain criteria set forth in part by CMS. This criteria is used to assist in identifying those Part D beneficiaries who have multiple chronic diseases and are at risk for medication-related problems.

One large health plan has developed a program to coordinate the efforts of the MTM program with case management. In addition to many other interventions, this MTM program offers a Comprehensive Call Center, which is a pharmacist-based case management initiative offering live comprehensive medication reviews via telephone conference. The integrated phone call allows participating beneficiaries the opportunity for one-on-one counseling with a pharmacist, while also having their case manager present and advised of medication changes. Pharmacists and case managers can answer questions over the phone and provide counseling and support.

Together the case manager and the pharmacist collaborate to make a difference with high-risk MTM participants. Medication-related issues are identified, and medication adherence is increased by enhanced communication between the case manager, pharmacist, and participant. Participant health concerns and medications are discussed thereby improving participant understanding, safety at home, and reducing overall cost of care. Tools such as a Medication Action Plan and Personal Medication Record are provided to the participant. The case manager reviews the tools with the participant to assist with care coordination.

Phase 1 of this program was presented at CMSA's 18th Annual Conference and Expo in Orlando. Phase 1 included an overview of the MTM program and goals for improved participant outcomes. This presentation will discuss Phase 2 of the Case Management collaboration with the MTM program, as well as ongoing evolution of the program design, goals, and intervention strategies. Recommendations for future development and best practices will be included.