Digital & Clinical Edits for Monitoring Medication Effectiveness and Risks
Our analyses provide clarity and help to prioritize high risk problems, providing hundreds of clinical edits and medication compliance/adherence results.
Our Patient Specific Quiries are monthly reports that are posted to a secure cloud location for medical and other plan directors to review at their convenience. You may find that a monthly consulting web meeting to review the results in these reports can be very beneficial.
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Key Points:
- An automated review of medication that is linked to:
- Billing
- EMR
- Patient Letters
- Prescriber Letters
- Identifying gaps in care and managing improvements by directing change and monitoring that change to achieve better clinical effectiveness and a lower risk
- Identifying the most complicated patients by aggregating the various edits from our Patient Specific Queries for improved quality of care with a clinical approach
Patient Specific Queries at Work
Problem: A client contacted with us to inquire if there was a simple, easy, affordable solution for complying with their State requirements for Drug Utilization Review (DUR). The client wanted to integrate the system/solution into their medical utilization management program, along with monitoring their Medication Therapy Management (MTM) program.
Methodology: We responded that there was already a program for analyzing clinical data which utilizes hundreds of clinical edits, patient severity, age/gender, geography, diagnoses, and including medication compliance. The program provides analyses that can be customized and/or produced across all clinical edits for the population. The results are Patient Specific Queries/reports that allow a client to monitor the performance of their MTM, and Comprehensive Medication Reviews (CMRs). The program is integrated on the cloud such that the Patient Specific Queries/reports are linked to pharmacy, physician and patient communications/letters as well as fully integrated billing forms such that every element is digital.
Outcome: The client received cloud-based, fully digital, regular monthly reports and analyses. The program met the criteria for easy, simple, no manual work, and affordability. All findings are trended so that improvements or corrective action plans can be instituted. The program also allowed the client to include a broad range of professionals (pharmacists, physicians, nurse practitioners) to deliver CMR, MTM and Targeted Medication Reviews (TMR) to improve their overall Star Ratings, while also delivering a quid pro quo opportunity for billing when appropriate. The ROI for these programs easily exceeded a 2:1 ratio.
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