Time to tackle the tough questions…

or one question really - will the Risks outweigh the Rewards?

What is your contracting process, how long does it usually take to move through to signing?

Our contracting process is simple. We can provide you with our standard contract and adjust to meet your organization’s needs, or we can sign a contract that you provide. We are very flexible and can move as fast as you are able.

We are considering using an internal team as a cost-saving measure, instead of using a vendor, any advice?

We would advise you to really run the numbers. Typically, an internal team is more expensive and requires more oversight than bringing on a partner like myMTMcare.

Bringing MTM in-house means hiring pharmacists, admin personnel and a manager to oversee the team. A software platform is another significant piece. When you bring on a team like ours, we have all the bases covered at a fraction of the cost. Give us a call, we are happy to talk through the details!

How can we take some of the risk out of making the switch?

Excellent question! While service guarantees are not a usual part of our contracts, if risk is a concern, then we will work with you to define a service-level guarantee that you feel comfortable with. Let’s align on what success looks like, and we will offer a cash-back guarantee if we do not meet our agreed upon goal. Now you have the confidence you need to make the switch, and a clearly defined goal for your MTM program!

I already have a platform for MTM. Do I need to switch?

If you have a platform you like, we are happy to work with it.

If you have a platform that you like and would like us to use it too, then we are happy to make that happen. We also have a great platform partner whom we work with, CSSHealth. We have been using the MTMPath platform from CSSHealth since 2015, and believe that it is the best available. Occasionally, a health plan has the need to switch or add platforms during the plan year. We can make this work as well. You never have to be stuck with a solution that isn't a good fit for you.


What MTM platform do you use? What are its capabilities?

myMTMcare has partnered with CSSHealth to provide a complete MTM solution for our clients. MTMPath is CSSHealth's SaaS application. The system's only user requirements are a browser and internet connection, and we allow as many users to access the MTMPath as you would like.

MTMPath is fully CMS-compliant. CSSHealth is currently one of the largest MTM providers in the country with over 45 clients using its software and services for MTM programs. Of these clients, 22 use the software for Medicare MTM programs.

One of the reasons we chose this software is that it is highly configurable. The application provides templates for health plans to create a configuration of the system that meets your program needs. All program eligibility rules, reporting drill-downs, clinician assessments, standardized patient/provider recommendations and clinical rules engine alerts can be modified by the plan either at implementation or periodically during a program year.

The MTMPath application includes:

  • A library of over 2500 therapy gap rules - each gap is associated with a recommendation, structured to conform to the PQA Drug Therapy Problem framework and contains both clinician and lay language.
  • Default language that can be modified by the program manager at the account level and by a clinician at the patient level.
  • Compendium of care gap alerts that are client/program specific and can be customized by the client.
  • Users are not restricted to creating care plans using therapy gap alerts presented by MTMPath - they are encouraged to also create their own recommendations.

How do you manage client services?

At myMTMcare, we aim to make an impact on those we encounter. It is our goal to make your experience with our team the best part of your day! And, we want to do the same for your members. Each of our clients have a dedicated phone line, an account manager and a pharmacist lead. All staff working on your account will be an extension of your own staff. We will have regular meetings, you’ll get regular reports, and our team is super responsive when something else comes up like audits, data issues, member issues, etc. We want to make sure that you feel heard and that you are not only getting results, but you are building a strong relationship with our team.

Are you able to offer retail pharmacy services?

We can add any entity to the network that you would like. If there is a retail pharmacy that is interested in being a part of your MTM team, then we can get them access to and training on the platform so that they can also complete CMRs on your behalf.


I am interested in knowing more about your pricing model

We use a fee for service model where our partners get exactly what they pay for. When our team's incentives are aligned with our performance, you get the quality and quantity of services that meet your expectations. Based on previous year's performance, eligibility, and your CMR completion rate goals, we can provide an estimate of your total cost for the annual MTM program so that you can be sure it fits your budget.

Where other vendors charge huge fees for “guaranteed rates,” we charge the same fee whether it’s CMR #1 or CMR #999. So when other vendors stop calling your patients because they’ve reached the guaranteed rate, at myMTMcare we keep going because we believe that your members are worth it. Don’t get lost among the big boys. Small to Mid-sized health plans are our sweet spot; where everyone is important, and all patients matter.

Learn more about our approach and why it works here.


Where are you in the process of adopting an FHIR-enabled MTM platform?

CSSHealth, our platform partner, was an early adopter to the HL7 standards and is committing to continuing its support for interoperability by becoming a FHIR-enabled MTM vendor in 2021. We have a shared opinion that fully embracing the FHIR standards only strengthens our commitment to patient centricity. MTMPath offers digital-first document delivery to providers who have provided valid digital endpoint data to the national registry, with robust integrations coming next year (in 2021).

What is your process for providing CMS files, responses, audits and other requested materials?

Each of our clients has a designated team here at myMTMcare that will provide you with all the information needed for your CMS MTM program submission, ongoing program audits, and beneficiary level reporting.

As your MTM partner, your myMTMcare team will provide off-site or on-site audit support at your request in the event of a CMS audit. This includes but is not limited to the annual data validation audit or other internal or external audits. Furthermore, for the MTM program audit, myMTMcare and CSSHealth attests that each currently has, and will continue to have, the ability to produce all audit universe data elements and documents, including but not limited to enrollment, CMRs and TMRs.

Any member of your team who would like access to MTMPath will be given an account. Through this account they will have access to all reporting functions, all patient data, and all information that has been recorded in the platform in the process of servicing your members.

In addition to all of this, our account team will deliver regular reports and support both scheduled, and as needed, based on your preferences.

Can you provide examples of regular reporting provided to customers?

Below is a list of reports available in our system:

  • BLR - universal file for all members in the MTM program
  • CMR Tracker - complete list of all completed CMRs indicating MR Number, patient information, enrollment date, enrollment status, date of interview, interview user and standard format date.
  • EESR - complete list of member participating status with CMR date, indicating MR Number, patient information, enrollment date, participation status, opt out information, and primary language.
  • Recommendation Extract - complete list of all Recommendations made for TMR/CMR, listing MR number, patient information, date of recommendations, reason, reply from physician and brief description of the recommendation.
  • Patient Contact Extract - complete list of all contacts made to members. Includes inbound/outbound, call type, call outcome, dates and user.
  • Billing Report - complete list of all billable MTM services (provided by myMTMcare)