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.
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
Achieve better Star, HEDIS®, and Display measures
Our Quality Improvement Program fosters member engagement and improves performance with comprehensive, precision targeting to monitor:
- 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.
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
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:
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
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
Contact a MedWise HealthCare associate
- U.S. Department of Health and Human Services. Adverse Drug Events. U.S. Department of Health and Human Services, 2020.