Every year, inadequate medication management costs the U.S. healthcare system as much as $300 billion, and critically, threatens your health plan’s Star Ratings. When the stakes are this high, can you afford to rely on inefficient, manual processes for your targeted medication reviews (TMR)?
Many health plans still treat the medication review process, a core component of medication therapy management (MTM), like a clinical chore, drowning their expert MTM pharmacists in fragmented data and outdated pharmacy software. This doesn't just waste valuable time. It translates directly into missed adherence measures, safety errors, and diminished patient outcomes.
The key to transforming the TMR from a burdensome obligation into a powerful driver of quality lies in adopting modern pharmacy technology. This shift, supported by scalable pharmacy SaaS platforms, allows remote pharmacists to achieve precision targeting, ensuring that every intervention helps improve overall quality of care.
A targeted medication review (TMR) is an element of the broader medication therapy management services, focusing on identifying and resolving specific, high-priority medication issues. Unlike a comprehensive medication review (CMR), which involves a deep, holistic review of all medications and health conditions, a TMR is typically a brief, actionable intervention centered on a single, known problem.
A TMR usually addresses issues flagged by a health plan's software or claims data. Common triggers include:
The primary goal of a TMR is to ensure the patient's drug regimen is safe, effective, and compliant with best practices, ultimately driving better patient outcomes and improving the health plan's quality measures.
While the concept of a TMR is simple – find a problem, fix a problem – execution can be complex and costly without the right pharmacy technology. When health plans rely on manual processes or outdated pharmacy software, they face several detrimental inefficiencies:
To overcome the challenges of inefficient TMR processes and maximize the value delivered by MTM pharmacists, modern pharmacy software solutions are essential. These platforms transform the TMR from a burdensome administrative task into a precise, scalable, and clinically impactful intervention, directly improving Star Ratings and health outcomes.
Modern pharmacy technology uses advanced algorithms to analyze vast data sets, including claims, clinical data, and EHRs, far faster and more accurately than manual methods. This allows for precision targeting, ensuring that remote pharmacists prioritize patients who are most likely to benefit from a medication review intervention.
Instead of working through generic lists, the system flags patients based on predictive analytics that account for risk factors, potential for savings, and alignment with specific quality measures. This eliminates wasted effort and dramatically improves the completion rate of high-value TMRs.
A key benefit of a robust pharmacy SaaS solution is the automation of routine, high-volume tasks. The platform handles the entire administrative lifecycle of the TMR, from initial patient identification to final documentation.
By removing the tedious burden of clerical work, the pharmacy technology preserves the pharmacist's cognitive load and job satisfaction, directly contributing to preventing pharmacist burnout.
Effective TMRs require culturally competent communication. Leading pharmacy solutions incorporate intelligent matching features that go beyond simple availability. They leverage data points, such as language preference, cultural background, clinical specialty, and even patient communication style, to pair the patient with the most appropriate remote pharmacist. This specialized matching fosters greater trust, improves patient engagement, and increases the likelihood of adherence and desired patient outcomes.
Modern pharmacy software enables real-time intervention and communication, which is critical for time-sensitive TMRs.
The final component of effective pharmacy SaaS is its ability to measure and report on the impact of TMR services. These systems provide comprehensive dashboards and analytics, giving health plans clear visibility into performance.
The impact of a targeted medication review is deeply intertwined with a health plan's performance on the Centers for Medicare & Medicaid Services (CMS) Star Ratings system. These ratings are crucial – they directly affect reimbursement levels, enrollment, and the plan's public reputation. Effective TMRs, powered by smart pharmacy technology, are a direct mechanism for improving several key quality measures.
TMRs primarily influence three critical domains within the Star Ratings framework:
TMRs are an effective intervention strategy for boosting medication adherence, which constitutes three highly weighted Star measures. More specifically, TMRs help flag and address medication non-adherence for chronic conditions. When these flags are discovered, the remote pharmacist uses the TMR encounter to address financial barriers, patient misunderstanding, or side effects, ensuring the patient continues their prescribed regimen.
TMRs contribute to these measures by targeting nonadherence, helping plans meet the 80% Proportion of Days Covered (PDC) threshold required for effective therapy. As adherence performance correlates with broader Part C outcomes, TMRs serve as a high-impact intervention for elevating overall Star Ratings and securing quality bonuses.
One key component of CMS quality measures is ensuring patient safety through their medication regimen. This measure focuses on reducing high-risk prescribing, and TMRs proactively identify patients receiving inappropriate medications. When this happens, the pharmacist communicates with the prescriber to recommend safer alternatives, preventing potential falls, confusion, and hospitalizations, thus improving the safety measure score.
Although TMRs are distinct from CMRs, the efficiency gained through pharmacy SaaS impacts both. By streamlining TMRs, the MTM pharmacist can dedicate more time to the higher-value, more complex CMRs as needed. Furthermore, successful TMR engagement can serve as an important early touchpoint, potentially increasing patient receptivity to a future CMR if qualified.
In short, a highly efficient TMR program built on advanced pharmacy software ensures the health plan addresses the right patient at the right time with the right message, creating a clear and trackable path to a higher Star Rating and superior patient outcomes.
To move from manual, reactive TMRs to a proactive, highly efficient system that maximizes Star Ratings and patient outcomes, health plans and risk-bearing entities can benefit from partnering with an experienced pharmacy solution provider – especially to enable timely, end-of-year adherence alerts that promote proactive outreach. The transition involves adopting technology that seamlessly integrates data, automates tasks, and, most importantly, empowers the pharmacist.
The first step is selecting a platform that covers the full spectrum of TMR and MTM needs, ensuring both operational efficiency and clinical excellence. That ultimately comes down to the audience, team, and ideal care delivery model.
For health plans looking to scale their TMR programs with their own pharmacist team, a dedicated SaaS platform designed for seamless workflow coordination is essential. Alliance by Aspen RxHealth facilitates precision patient targeting, automates compliance documentation, and offers the data-driven reporting necessary to optimize quality measures. This solution is the ultimate enterprise engine for driving TMR performance.
Aspen RxHealth’s community of pharmacists can improve TMR performance by meeting patients where they are, through platforms like BeWell, a fully integrated, web-based solution that streamlines clinical consultations, documentation, and compliance reporting while providing access to real-time patient data to drive better health outcomes. With Aspen RxHealth, remote pharmacists have the opportunity to connect with patients via telehealth consultations for accurate medication management, regardless of setting.
By integrating these advanced technologies, health organizations transform their TMR program into a strategic asset. The days of simply checking boxes are over; the future of the medication review process is about using pharmacy technology to connect the right patient with the right MTM pharmacist at the precise moment of clinical need. This scalable approach not only protects revenue by improving Star Ratings but also reinforces the core mission of healthcare: delivering superior patient outcomes.
To start streamlining targeted medication reviews, reach out to Aspen RxHealth today to book your demo!