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Services for Medicaid

Dedicated to the science of better outcomes, MedWise HealthCare offers individualized programs to best fit member needs. From award-winning software to full-service solutions, we offer excellent options for medication decision support in Medicaid populations.

Each point decrease in a MedWise Risk Score represents an average

annual savings of $1,000 per member1.

“We were excited about starting this program because we can evaluate the impact on the total cost of care. So, that’s pharmacy and medical. [To provide one example,] 60 days after MedWise® Safety Reviews were completed, we saw a [MedWise] Risk Score decrease from 23 to 14.”

– Rob Berringer, PharmD, Magellan Complete Care

Quality improvement

Promote better HEDIS® measures

Our Quality Improvement Program fosters member engagement, promotes adherence, and improves performance measures with comprehensive, precision targeting to monitor:

  • Adherence
  • Medication/disease state opportunities
  • Drug-disease interactions
  • Safety concerns
  • Opioid overutilization prevention

Reduce readmissions with medication reconciliation

Our care transition services offer in-home and virtual comprehensive medication reconciliation to support compliance with Healthcare Effectiveness Data and Information Set (HEDIS®) measures and reduce readmissions in members who fall under special needs plans (SNPs).

  • The Transitions of Care Program supports chronic and complex care management
  • The Medication Reconciliation Post-Discharge Program helps to meet HEDIS® measures by identifying and mitigating risks associated with adverse drug events (ADEs) to improve member safety and curb healthcare expenditures
  • On average, between 2.2 and 2.8 discrepancies are identified per in-home visit medication reconciliation.

“By prioritizing medication safety and effectiveness, our unique risk mitigation platform can help physicians provide the best possible care to patients transferring from hospitals or rehabilitation facilities to their homes and, ultimately, reduce readmissions.”

– Kenneth Goldblum, MD, FACP, Tandigm Health Chief Medical Officer

Clinical programs

Improve outcomes with medication therapy management (MTM)

MedWise MTM works for health plans by offering targeted medication reviews to support member well-being, medication adherence, and opioid management. Our services and solutions also help pharmacists meet state and federal standards for clinical programs.

Decrease costs with  MedWise  Predictive MTM

Powered by proprietary MedWise  Science, MedWise Predictive MTM elevates traditional MTM platforms to realize total cost-of-care reductions in the same plan year by assessing multi-drug interactions cumulatively and improving member outcomes by personalizing medication regimens. Further, our nationwide clinical contact centers, extensive network of community pharmacies, and multichannel digital communications keep members engaged.

Improve communication using the Fonebook platform, a contact registry to

manage, add, and automatically update member contact information.

Peace of mind with a MedWise Safety Review

A MedWise Safety Review offers a comprehensive risk assessment through our certified pharmacists. They can help determine a member’s risk for ADEs, emergency room visits, and hospitalizations and offer solutions to minimize that risk. Additionally, MedWise HealthCare can help improve opioid utilization with better medication adherence and reconciliation.

For managed care organizations, the Medicaid Medication Risk Reduction Program can:

  • Target high-risk populations for increased efficiency
  • Identify medication-related risk with simultaneous multi-drug analysis
  • Mitigate ADEs
  • Reduce total cost of care
  • Provide better quality of care, health-related outcomes, and performance according to HEDIS measures and the Consumer Assessment of Healthcare Providers and Systems program

Healthy living

We foster collaboration, personalized medication recommendations, and follow-up consultations between members and providers to promote healthy living practices through:

  • National Diabetes Prevention Program: In partnership with the American Pharmacists Association (APhA) Foundation and funded with an award from the Centers for Disease Control and Prevention (CDC), this complimentary program provides lifestyle coaches via telehealth services to help prevent type 2 diabetes
  • Smoking Cessation Program: Smoking cessation solutions based on medical and smoking history, individual preferences, and previous attempts to quit

Contact a MedWise HealthCare associate

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References

  1. Bankes D, Jin H, Finnel S, Michaud V, Knowlton C, Turgeon J, Stein A. Association of a novel medication risk score with adverse drug events and other pertinent outcomes among participants of the Programs of All-Inclusive Care for the Elderly. Pharmacy. 2020 May 20;8(2):87.

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