Hundreds of billions of dollars of unnecessary medical cost is lost annually due to medication adherence-related problems. This avoidable medical spend is central to the success of value-based care programs where quality improvement is primarily measured by consumer outcomes. With billions of annual federal and state performance incentive dollars at stake, health plans are challenged to capture these value-based care payments.

For more than a decade, PharmMD has helped Medicare Advantage, managed Medicaid and Commercial plans improve pay-for-performance programs such as Star Ratings. In 2019, approximately 50 percent of the Medicare Advantage Star Ratings will be weighted on medication adherence-related outcome measures. These complex quality measurement systems require technologies that engage consumers and their providers to close care gaps. By focusing on resolving medication adherence-related problems to advance better population health, health plans can maximize their financial investment for quality improvement and improve plan performance.

Adhere™ is PharmMD’s medication-focused platform of integrated solutions that uses advanced analytics to stratify consumer populations, prioritize interventions and resolve gaps in care to achieve value-based care outcomes. Adhere™ encompasses massive comparative benchmark data sets, powerful analytics and a nationwide clinical network to improve health outcomes and financial performance. With increasing pressure on health plans to achieve higher quality ratings, partners willing to share risk around program performance is crucial. PharmMD's performance-based alignment with health plans creates a shared risk that uniquely guarantees that each consumer measurement conversion fee is a value.

Resolve™

Clinical decision support solution with medication adherence focused intervention services

Resolve is PharmMD's comprehensive clinical decision support solution with medication adherence focused intervention services that delivers guaranteed performance for each consumer and their related quality measure. Using dozens of data sources, PharmMD clinicians leverage expert clinical workflow tools to guide telephonic and digital consumer dialogue regarding their medication adherence problems. Resolve™ delivers improved population health one consumer at a time thorough understanding each individual's social determinants of health, gaining commitment to improve quality, coordinating with the provider care team and leveraging real-time adherence surveillance.

Powered by QiLink™, a workflow tool that integrates Stratify™ analytics with consumer and provider engagement data, each clinical intervention incorporates commitment to follow up that advances health improvement. This advanced data-driven solution has over a decade of exceptional outcomes bolstered by a consumer and measure specific adherence risk guarantee.

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OptimizeMTM™

Medication Therapy Management solution that addresses client goals and regulatory requirements.

OptimizeMTM™ is a Medication Therapy Management (MTM) solution that addresses client goals and regulatory required needs by incorporating Stratify™ analytics. Leveraging our P3Link™ expert clinical decision support tool, the program structures all regulatory requirements of consumer eligibility, data validation, offer letter generation and fulfillment and end-of-year reporting requirements. Powered by our Stratify™ analytic engine, OptimizeMTM™ addresses care gaps associated with HEDIS, Part C and Part D measures with real-time analysis based on historical claims data and consumer input. The solution drives efficient clinical workflows and regulatory reporting requirements, enabling clinicians to focus on delivering consumer-directed care.

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