MTM performance metrics on your Dashboard display the MTM performance score, percentile rank and opportunity completion rates for your MTM Center. These performance metrics will update on your Dashboard weekly and represent activity year to date for the current calendar year.
| Performance score & percentile rank is how your MTM Center (pharmacy or practice site) is performing compared to all other MTM Centers. Scores are measured on a curve using a scale of 0 (lowest) to 5 (highest) based on successful outcomes for CMR and TIP opportunities for primary and non-primary patients. Percentile is measured on a scale of 1% (lowest) to 99% (highest). Example: 75% indicates that pharmacy is performing better than or equal to 75% of participating pharmacies. |
TIP completion rate |
CMR completion rate |
*Primary opportunities = CMR and TIP opportunities for patients who fill at your MTM Center (pharmacy or practice site) more than any other MTM Center
How is my MTM performance score determined?
Your MTM Center (pharmacy or practice site) is assigned a score between 0 and 5 (5 being the highest) based on your CMR and TIP completion rates.
Based on performance in the evaluation categories, MTM Centers are measured on a curve against all other MTM Centers.
MTM performance score scale:
- N/A indicates the MTM Center did not have any primary CMR or TIP opportunities and could not be assigned a score.
- 0 indicates the MTM Center did not complete an intervention with a successful outcome.
- 1 indicates the MTM Center ranks in the bottom 20% of MTM Centers (well below average)
- 2 indicates the MTM Center ranks in the 20%-40% of MTM Centers (below average)
- 3 indicates the MTM Center ranks in the 40%-60% (average)
- 4 indicates the MTM Center ranks in the 60%-80% (above average)
- 5 indicates the MTM Center ranks in the top 20% (best in class)
How do I improve my performance metrics?
Attempt to resolve 100% of MTM opportunities for both your primary and non-primary patients. We suggest working from the top of your MTM Opportunities queue on the Dashboard, which prioritizes patients for you.
If you are attempting the majority of your opportunities but your score remains low, work on achieving more successful resolutions to TIPs and increasing patient acceptance for Comprehensive Medication Reviews (CMRs). When logged into our OutcomesOne™ platform, click the Menu button in the upper right and select Resources. This section offers workflow guides filled with best practices and links to a library of short webinars to help you increase successful outcomes. You may also contact our help desk for assistance with resources or best practices. We're available at (877) 237-0050, Monday-Friday, 7 AM-7 PM Central Time.
What is considered a successful result for a TIP or CMR?
A successful result indicates the objective of the intervention was achieved, such as CMR – Drug Therapy Problems Identified, Initiated Therapy or Adherence Check-in Completed.
When counting completed (successful) services, we exclude these results:
- Patient Refused
- Prescriber Refused Recommendation
- Unable to Reach Patient/Prescriber After 3 Attempts
- No Intervention Needed
It is not my fault patients refuse or I cannot reach them. Why does it hurt my score?
We understand that not every intervention will end in a successful outcome. MTM performance scores are calculated on a curve to give you an idea of how your MTM Center is performing compared to other MTM Centers, which also likely have attempted interventions for patients or prescribers who refuse or are unable to be reached.
If your MTM Center is struggling with successful outcomes to certain services, visit our Resources section (via Menu button in the upper right) or call our help desk at (877) 237-0050 for suggested best practices on communicating with patients, making recommendations to prescribers or integrating MTM into your workflow.
Does submitting a TIP as No Intervention Needed affect my MTM performance score?
It depends on whether the TIP is for a primary patient or not. Since your denominator includes TIP opportunities for primary patients that were available for 7 days, this TIP is already factored into your score. Submitting the TIP as No Intervention Needed will not decrease your score further than not acting on the opportunity or submitting the claim with an unsuccessful result. Submitting non-primary TIP opportunities as No Intervention Needed will not impact your score. Your performance is graded on a curve compared to all other MTM Centers, which also encounter situations where the intervention is not needed. If your MTM Center has a typical proportion of No Intervention Needed submissions, it’s likely not negatively impacting your MTM performance score.
Best practice: Play the long game! Providing quality care to non-primary patients and helping them resolve drug therapy problems may encourage them to become a primary patient at your pharmacy. Plus, successful outcomes to these interventions can improve your MTM performance score.
What happens to my score if I don’t work on opportunities for primary patients?
If other MTM Centers improved their performance and your MTM Center didn’t act on any opportunities, your score may go down. If an opportunity is available for at least 7 days and you do nothing, select No Intervention Necessary or submit the claim as a refusal or unable to be reached, your score will be negatively impacted. The degree of the impact on your score is dependent on the volume of opportunities already in your MTM Center’s denominator and how other MTM centers are performing as well.
NOTE: Primary patients don’t apply to non-dispensing MTM Centers, such as clinics.
How does my MTM performance score impact Star Ratings or my EQuIPP rating?
The MTM performance score your MTM Center receives from Outcomes is determined using our own internal calculations in order to evaluate how well MTM providers perform compared to one another. Aggregated MTM Center performance is provided to our health plans to give them insight into how engaged our network is.
If you have a high MTM performance score, your performance will appear more favorable to health plans, but pharmacies do not directly get a Star Rating. Outcomes services, including CMRs and TIPs, can help you impact Medicare plans’ Star Ratings.
Your MTM performance score from Outcomes does not correlate to an EQuIPP rating. However, CMRs and targeted interventions for adherence and statin use can help you get paid to address issues that may improve your EQuIPP rating.
How does this MTM performance score affect my DIR fees?
DIR fees are based on different calculations/metrics established in contracts your organization has with health plans or PBMs. We do not have access to that information and cannot comment on specific impact of services completed within Outcomes programs. However, if DIR fees are related to adherence or CMR completion, acting on services through Outcomes may positively impact your performance in those contracts.