Insights Beyond The Counter

The Evolution of MTM: What 2025 Tells Us About What’s Next

In this episode of Insights Beyond the Counter, hosts Jon Grice and Lauren Adair discuss how MTM continues to prove its value - not just clinically, but economically. In this conversation, we highlight a record-breaking 2025 for MTM within the Outcomes network, with 11.6M completed claims, growing pharmacist and technician engagement, and over $190M in clinical revenue generated. But what’s most interesting isn’t just the growth, it’s the shift. We’re seeing movement beyond traditional CMRs toward adherence-driven programs, longitudinal patient engagement, and expanded clinical services like A1C and blood pressure monitoring. Looking ahead, changes tied to CMS ratings in 2027 will bring renewed focus (and volume) to CMRs, making now the time for pharmacies to rethink workflows, staffing models, and technology investments. The takeaway: MTM isn’t static. It’s evolving and pharmacies that plan for what’s next will be best positioned to capture both clinical and financial impact.

Transforming Member Outreach Through Pharmacy

In this episode of Insights Beyond the Counter, hosts Shane Hallengren and Amit Patel unpack the rapidly evolving world of health risk assessments (HRAs) and social determinants of health (SDOH) across Medicaid and Medicare. Fresh off the Medicaid Innovations Forum, Amit shares insights from health plan leaders navigating a post–Public Health Emergency landscape defined by redeterminations, workforce shortages, and persistent challenges with member contactability. Shane reflects on his years supporting Medicare performance programs and draws parallels between the two sectors—especially around how HRAs have shifted from simple “check‑the‑box” tasks to powerful tools that uncover transportation barriers, food insecurity, medication access challenges, utility instability, and more. Together, they explore: * Why SDOH data is only valuable when it leads to meaningful action * How community pharmacies—as trusted, accessible care touchpoints—are uniquely positioned to conduct sensitive assessments * The growing importance of rural health transformation and how pharmacies can close engagement and adherence gaps * How Outcomes is supporting pharmacies with technology, workflows, and scalable programs that enable efficient, person-to-person care * What the future may hold as Medicaid and Medicare strategies continue to evolve If you’re passionate about healthcare innovation, population health, or the expanding role of pharmacy, this conversation is packed with real-world insights you won’t want to miss.

Making MTM Central to Clinical Strategy

In this episode, host Jon Grice takes a candid and timely look at the evolving role of Medication Therapy Management (MTM) in community pharmacy. Jon raises an important question: Are pharmacists missing a critical opportunity hiding in plain sight? He explores why MTM remains essential—not just for patient care, but for the financial sustainability of today’s pharmacies. He discusses the shifting landscape where dispensing margins have eroded, clinical services have become the new value driver, and yet emotional and historical frustrations with payers may be holding some pharmacists back from embracing what’s next. Drawing on conversations with industry leaders and his own lived experience as an independent pharmacist, Jon challenges listeners to re‑examine assumptions, recognize cognitive biases, and reconnect with the shared goals of insurers, pharmacies, and patients. Whether you're a chain pharmacist, an independent owner, or someone trying to understand the future of clinical care, this episode offers a grounded, honest look at where MTM stands—and where it needs to go next.

Preparing for the Return of CMR

In this episode, host Ross Frei, Senior Product Manager and resident MTM/CMR strategist, sits down with Cindy Henry, Director of Payer Products at Outcomes, to unpack one of the biggest changes hitting Medicare Advantage plans: CMS’s intent to return the CMR completion rate to the Star Ratings program beginning in measure year 2027. Ross and Cindy explore how the industry reacted to the latest CMS Advance Notice, why the CMR measure’s return matters, and how MTM strategy has quietly shifted during its two‑year placement on the display page. Together, they outline the pressures plans are feeling—from shrinking margins to rising expectations around clinical quality—and the renewed focus on the value of medication therapy management, total cost of care, and local pharmacy engagement. A key topic throughout the episode is the impact of CMS’s expanded MTM eligibility criteria, which significantly increases denominators for 2025 and beyond. Cindy explains how this shift forces payers to rethink scale, budget, ROI, and operational models, while Ross shares Outcomes’ cut‑point predictions and how performance is likely to redistribute once the measure becomes active again. The conversation also highlights Outcomes’ strategy to support both health plans and community pharmacies as they prepare for 2027. Ross describes work underway to reduce documentation burden, streamline workflows, leverage new technology, and allow pharmacists to practice at the top of their license—ultimately helping MTM delivery scale without sacrificing quality. By the end of the episode, the message is clear: Plans that begin modeling, staffing, vendor alignment, and workflow modernization now will be best positioned when Star Ratings recalibrate in 2029. Listeners are encouraged to explore Outcomes’ latest prediction models and analysis at outcomes.com.