Five Key Focus Areas for Better Outcomes
With the increasing complexity of chronic disease management continuing to challenge both health plans and providers, Comprehensive Medication Management (CMM) has become one of the most powerful levers to improve outcomes and reduce unnecessary utilization. But the true value of CMM is only realized when its foundational elements are executed effectively and consistently.
Many organizations struggle with limited pharmacist capacity, fragmented data sources, and manual processes that make it extremely difficult to proactively identify medication-related risks, predict non-adherence, or optimize medications at scale. When these core elements fall short, clinical teams miss vital care opportunities – resulting in higher costs, avoidable hospitalizations, adverse drug reactions, and underperformance across medication-related quality measures.
Based on our work with payers and providers, here are the five essential components a high-performing Comprehensive Medication Management program should include.
Identify the Right Patients for CMM – Including Both High-Risk and Rising-Risk Individuals
A successful CMM program starts by ensuring organizations focus their efforts on the right patients, at the right time, with the right interventions.
While some organizations default to targeting only patients with high past utilization costs, this approach often misses patients who are at high risk for future complications. To drive larger-scale impact, it’s essential to proactively prevent medication-related risks by evaluating a patient’s current clinical state, medication regimen, and risk trajectory, not just historic claims.
High-performing programs also identify rising-risk patients – those who are not yet high-cost but are trending toward worsening outcomes. Without proactively flagging these individuals, interventions may occur only after issues escalate, when they are harder and more expensive to address.
Deliver Interventions at the Right Time and Predict Non-Adherence Early
Timing is just as important as identifying the right patients. Many teams intervene only after a patient becomes non-adherent or accumulates avoidable clinical issues – at which point recovery within measurement periods may be challenging.
Non-adherence is one of the main drivers of quality underperformance, yet traditional approaches identify non-adherence too late. Effective CMM depends on:
- Predicting non-adherence early and intervening proactively
- Identifying the clinical root causes of non-adherence
- Understanding each patient’s medical history and other medication-related risks before outreach
Without comprehensive patient-specific clinical insights, quality teams struggle to close care gaps efficiently. Proactive adherence interventions not only improve quality metrics but also enhance health outcomes and reduce costly medical complications.
Delivering Truly Personalized Medication Optimization
Personalized medication optimization is at the heart of CMM. A “one-size-fits-all” approach fails to address the unique needs and complexities of individual patients.
Effective programs evaluate each patient holistically, including:
- Medical history
- Current and past medications
- Current diagnoses and comorbidities
- Lab values
- Demographic factors
Personalized medication optimization ensures therapy plans are clinically appropriate, safe, feasible, and more likely to support adherence and sustained outcomes.
Provide Clear, Actionable Recommendations for Providers
Even the strongest clinical insights fail to drive impact without clear, actionable plans for both providers and patients.
Strong CMM programs ensure:
- Recommendations include prioritized and specific actions for medication regimen changes
- Suggested medication changes should not be an overwhelming list of actions – they need to be feasible to implement
- Each recommendation includes patient context and clinical rationale, enabling physicians to make informed decisions
- Communication is streamlined within provider workflows, increasing the likelihood that recommendations are implemented
Clarity and prioritization help translate insights into real-world care improvements.
Commit to Ongoing Evaluation, Monitoring, and Continuous Improvement
Patients shift between risk categories as conditions evolve, medications change, or new life circumstances emerge. Both the CMM program and each individualized care plan should be treated as living documents.
This includes:
- Continuously monitoring patients’ risks, adherence, and outcomes
- Refining prioritization logic and eligibility criteria based on performance
- Measuring impact at both the patient and population level
- Adjusting strategies to improve efficiency and quality outcomes
Organizations that routinely measure their program’s clinical, financial, and operational outcomes and adjust their strategies accordingly consistently achieve better results, including improved clinical outcomes, higher quality measure performance, and stronger financial ROI.
Schedule a call to learn how MDI Health can support your medication management programs: info@mdihealth.com