Care Coordination – Blue Cross and Blue Shield of Minnesota



Q&A Medication Reconciliation Review with Tabula Rasa 7-12-2018 Q: Do we still send in form 6.35 even if Tabula Rasa is getting the D/C paperwork?A: Yes. Form 6.35 In-Home Pharm D Referral Form provides the pharmacist with additional information including the Care Coordinator and Care Coordinator contact info, caregiver info as applicable, and the opportunity for you to provide additional information about the member’s environment or other needs.Q: The 6.35 form is only IF the member wants to see the pharmacist, right?A: No, it is required for all SecureBlue MSHO members who you know are experiencing a hospital admit. It is recommended to send this form as soon as you are notified of the admit. Upon discharge, the pharmacist will contact the member and/or caregiver to explain the benefits of the visit and schedule.Q: So, we don't wait to hear from the pharmacist? We should send 6.35 on all MSHO members coming out of the hospital?A: Yes, it is best to send the form as soon as you hear about the member’s transition to the hospital.Q: Is this benefit available to MSHO members who reside in an intermediate care facility for persons with developmental disabilities (ICF/DD)?A: Yes. It is available to all SecureBlue MSHO members except those residing in a nursing home.Q: What is the difference between this medication reconciliation and the Comprehensive Medication Review (CMR) that is offered by BCBS?A: Medication reconciliation by Tabula Rasa happens at a critical time when it’s medically necessary to review the member’s list of medications and significantly decrease the likelihood of re-hospitalization within 30 days. It is also done by a pharmacist in the member’s home. All SecureBlue MSHO members can receive medication reconciliation post-discharge. This review focuses on clarifying which medications should be continued or stopped after hospitalization based on discharge orders.? This review looks at what the member was taking prior to admission and what they were discharged to home with and identifies discrepancies.? An updated medication list is provided to the member after the visit.?Comprehensive Medication Review is a specially trained one-on-one medication review with a pharmacist completed over the phone instead of in the member’s home with specific eligibility criteria including having 3 or more specific chronic conditions, taking 8 or more covered Medicare Part D medications, and have an annual Rx drug spend of $3,967 or more. These visits are focused on identifying, resolving, and preventing medication related problems related to medication appropriateness, effectiveness, safety and member adherence.? An updated medication list and recommendations are provided to the member and communicated with the member’s provider after the visit.? All MSHO members may receive a CMR, but a subset of members at high risk of medication problems are targeted to receive the service.? You can use the warm transfer process to schedule CMR visits with your members.Q: What is the difference between this program & the MedXM in-home assessment program? A: Great question, they are two completely different benefits. MedXM is our partner vendor who visits new SecureBlue MSHO enrollees in their home to assess their current health care conditions and needs to provide information to both CMS/Medicare and the member’s primary care physician. This visit is a comprehensive overview with the member of all their healthcare needs, whereas, medication reconciliation with Tabula Rasa is a review of their medications only. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download