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Chapter 5. Payer Perspective

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MTM may be sponsored by:

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a. CMS Medicare.

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b. employers.

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c. Medicaid.

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d. managed care organizations.

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e. All of the above.

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Part C performance measures are heavily influenced by:

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a. HEDIS, which was developed by NCQA.

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b. HEDIS, which was developed by JCAHO.

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c. HEDIS, which was developed by PQA.

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d. HEDIS, which was developed by CMS.

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e. HEDIS, which was developed by the pharmacy group that created the MTM consensus document.

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Reasons to select telephonic over face-to-face MTM delivery include all of the following EXCEPT:

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a. ability to record each communication service for oversight and quality assurance of MTM providers.

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b. limited distractions that may be present in a retail pharmacy setting (ie, no dispensing functions, drive-thru, or waiting patients).

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c. ability to reach members unable to travel to a pharmacy (ie, non-ambulatory members).

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d. they are proven more effective than busy retail pharmacy setting.

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e. elimination of judgments on the part of the provider or patient, based on the physical attributes of the other.

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MTM services provided to patients who are not enrolled in Part D are:

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a. not required to follow CMS guidelines.

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b. required to follow HEDIS measures.

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c. required to be part of an ACO.

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d. required to use pharmacists as providers.

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e. required to provide a medication action plan.

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Complementary programs to MTM can include:

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a. a newsletter.

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b. a toll-free pharmacy hotline.

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c. educational materials.

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d. pill boxes.

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e. All of the above.

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When deciding between MTM program insourcing versus outsourcing, consideration must be given to all of the following EXCEPT:

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a. quality assessment process.

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