Per Member, Per Month? Not for myMTMcare!

In the not too distance past, myMTMcare provided MTM services for a larger MTM vendor. We enjoyed working for this vendor – there were a variety of patients and health plans, and the work was good. 

We started having great success with a particular health plan. Their patients almost always said "yes" to completing a CMR with one of our pharmacists, and speaking with them was usually pleasant and productive. We were on track to achieve a great CMR completion rate, but then something happened that we didn't expect. The MTM vendor told us that we had to stop calling patients from this plan. "Why? There are eligible patients who need the service, and we are ready and willing to call," we said.  

This experience was early in my career as an MTM services provider, before I got wise to the ways of industry pricing. I had yet to hear of the term "per member, per month." All I knew was that a business decision made by some corporate types meant that our patients, people who needed the service, were eligible, and had a right to a comprehensive medication review, were not getting our call. 

Here's how it works... 

MTM vendors typically set prices using a "per member, per month" fee. This fee is based on the total population, where the MTM vendor manages the whole population and is accountable for improving their health. At least, that's how it works in most other health care settings. But does it work for MTM? I would argue, No! It encourages the vendor to only meet the minimum contracted CMR completion rate so that they can control their own costs. Once I understood this, I decided then and there that I would never sign a contract that dis-incentivized my company from calling our patients and helping them with their medications. 

Our pricing model is different from most of the industry. myMTMcare prices our MTM services as a "fee for service." Our health plans always get what they pay for. 

But, we know how the industry works, so to give you give you the best pricing equivalent we created a "per member, per month" calculator using estimates and projections. You can check it out at myMTMcare.com. For most health plans, "our per member, per month" cost is going to be less than you're paying, and you're going to get a much higher CMR completion rate to boot! 


Published

Apr 3, 2017

Category

Business

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