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Services for Medicare

MedWise HealthCare is dedicated to the science of better outcomes, with individualized programs to best fit your unique needs. From full-service solutions to an award-winning software platform, we offer the best medication decision support for your Medicare population.

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Medication therapy management

Boost outcomes with MedWise® MTM

We provide targeted medication reviews and collaborate with health plans for guaranteed completion rates of Comprehensive Medication Reviews (CMRs), according to the Centers for Medicare and Medicaid Services (CMS) mandates. MedWise MTM keeps members engaged with:

  • Digital communication via text, email, and video
  • Telephonic outreach from multilingual teams at our nationwide MedWiseRx clinical contact centers
  • Face-to-face consults at our network community pharmacies

Improve communication with Fonebook

Maintaining regular correspondence with members is crucial to outcomes and adherence. Our exclusive partnership with Prove fosters connection using the FonebookTM platform, a contact registry to help health plans contact their members more effectively by managing, adding, and automatically updating phone numbers for increased engagement and CMR completion rates.

MedWise MTM software maintains over 1,200 clinical algorithms to target 75 qualifying conditions. This award-winning platform allows you to tailor processes, including:

  • Customized rule sets based on your member population
  • Personalized reports, including real-time dashboards, for CMS requirements and data validation audit support

Reduce costs with MedWise Predictive MTM

MedWise Predictive MTM elevates traditional MTM programs using our proprietary MedWise Science, which assess multi-drug interactions cumulatively to improve member outcomes and realize total cost-of-care reductions in the same plan year.

Members at an increased risk for adverse drug events (ADEs)—or those with a MedWise Risk Score of 20 or higher—are eligible for enhanced services, such as:

  • Reviews of additional parameters that may increase the risk for ADEs
  • Real-time updates on their MedWise Risk Score and medication recommendations

Quality improvement

Hands counting medications

Achieve better Star, HEDIS®, and Display measures

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

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

We can help you improve opioid utilization and more easily adhere to Medicare’s display measure for the Use of Opioids at High Dosage and from Multiple Providers in Persons Without Cancer.

Care for older adults

Advance the prevention, management, and treatment of chronic diseases.

Our Care for Older Adults (COA) Program assesses the percentage of members over 66 years of age who are in need of a medication review and pain screening at least once during the program year.

Elderly man speaks with younger woman while holding coffee

Reach this critical HEDIS® measure through:

  • Live member communication and follow-up with a personal medication list and comprehensive action plan
  • Opportunities for comprehensive continuity of care
  • Automated faxes to prescribers with members’ complete medication lists and pain assessments
  • Open dialogue between members and prescribers, providing continuity of care in pain assessment and medication safety
  • Fast and modernized reporting for informed decision-making and precision targeting 

Drug management

Exceed new CMS requirements.

We are equipped to support your drug management needs through our highly specialized, provider-focused, and CMS-compliant Drug Management Program. What makes MedWise HealthCare’s Drug Management Program different? Our proactive approach to drug management offers early identification, comprehensive provider outreach performed by clinical case managers, and proven results.

Millions of eligible members

Fully CMS compliant

Scalable and effective engagement

“The CMS auditor has informed us that we have passed the Primary Source Verification audit with no issues! Thank you for all your hard work and improvements. It made all the difference!”

– Health Plan Project Manager

Transitions of care

Medication reconciliation with a certified MedWise Advisor™

We help transition patients by providing comprehensive medication reconciliation from a certified MedWise Advisor pharmacist both at home and virtually. The Medication Reconciliation Post-Discharge Program can be customized to reduce hospitalizations and readmissions, thereby avoiding penalties and improving Star Ratings in:

Health systems
Provider groups
Health plans

The program also helps to meet Healthcare Effectiveness Data and Information Set (HEDIS®) measures by identifying and mitigating risks associated with ADEs to improve medication safety and reduce medical expenditures. On average, between 2.2 and 2.8 discrepancies are identified per in-home visit medication reconciliation.

On average, ADEs result in an estimated

1 million annual visits to the ER.1

Healthy living

MedWise HealthCare promotes member-provider collaboration, personalized medication recommendations, and follow-up consultations with the:

  • Care for Older Adults Program: Live communication and follow-ups to help Medicare Part C members understand and maintain their prescriptions, including personal medication lists
  • National Diabetes Prevention Program: Complimentary program that provides lifestyle coaches via telehealth services to help prevent type 2 diabetes, in partnership with the American Pharmacists Association (APhA) Foundation and funded by an award to the APhA Foundation from the Centers for Disease Control and Prevention
  • Smoking Cessation Program: Appropriate smoking cessation solutions based on members’ medical history, smoking history, past quit attempts, and individual preferences
Older healthy woman lifting weights

Contact a MedWise HealthCare associate

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  1. U.S. Department of Health and Human Services. Adverse Drug Events. U.S. Department of Health and Human Services, 2020.

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