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Rao P, Hung A. Impact of medication therapy management programs on potentially inappropriate medication use in older adults: A systematic review. J Manag Care Spec Pharm 2024; 30:3-14. [PMID: 38153866 PMCID: PMC10775773 DOI: 10.18553/jmcp.2024.30.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is prevalent, costly, and harmful for older adults. These medications are to be avoided among older adults because they generally have (1) a high risk of adverse events in this population and/or (2) limited evidence of benefits in the presence of safer or more effective alternatives. Medication therapy management (MTM) programs can help address PIM use; however, there has not been a synthesis of studies examining the impact of MTM programs on PIM use. OBJECTIVE To review published literature evaluating the impact of MTM on PIM use in older adults. METHODS A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines using MEDLINE (PubMed) studies were included if they (1) had a Medicare population, (2) were based in the United States, (3) examined an MTM program (ie, used the term "medication therapy management"), (4) focused on the impact of MTM programs on PIM use as the primary outcome, (5) had a randomized controlled trial or an observational study design, and (6) were available in English. RESULTS Of 221 articles identified, 31 full-text articles were assessed, and 7 met all inclusion and exclusion criteria. The studies took place in various settings, ranging from single-site tertiary medical centers to multisite outpatient clinics, community pharmacies, and nationwide telehealth MTM providers. Patient populations were majority female sex (ranging from 61% to 71%) and majority White (ranging from 81% to 94%), with a mean age of 73 to 78 years. In 5 of the 7 studies, MTM reduced the use of PIMs; however, 3 did not adjust for confounding or apply a comparator group. Measurement of MTM impacts on PIM use varied across studies. Patient-level and plan-level studies mostly assessed shorter-term PIM usage reduction (4 months or less), whereas studies performed at the provider and institutional level assessed PIM usage reduction trends across consecutive measurement years. CONCLUSIONS Based on the current limited evidence, MTM programs in older adults appear to have a positive impact on reducing PIM use. However, evidence was limited by study design, the lack of consistency in outcome measures, and a short follow-up period. Future work should adjust for confounding, apply comparator groups, include longer-term outcomes, and develop a core set of measures that can be consistently applied across studies.
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Affiliation(s)
- Preeyanka Rao
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Anna Hung
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, NC
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC
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Garuccio J, Tsang CCS, Wan JY, Shih YCT, Chisholm-Burns MA, Dagogo-Jack S, Cushman WC, Dong X, Browning JA, Zeng R, Wang J. Racial and ethnic disparities in the enrolment of medicare medication therapy management programs. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2023; 14:188-197. [PMID: 37337596 PMCID: PMC10276885 DOI: 10.1093/jphsr/rmad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/14/2023] [Indexed: 10/25/2023]
Abstract
Objectives Racial/ethnic disparities have been found in prior literature examining enrolment in Medicare medication therapy management programs. However, those studies were based on various eligibility scenarios because enrolment data were unavailable. This study tested for potential disparities in enrolment using actual MTM enrolment data. Methods Medicare Parts A&B claims, Medication Therapy Management Data Files, and the Area Health Resources File from 2013 to 2014 and 2016 to 2017 were analysed in this retrospective analysis. An adjusted logistic regression compared odds of enrolment between racial/ethnic minorities and non-Hispanic Whites (Whites) in the total sample and subpopulations with diabetes, hypertension, or hyperlipidaemia. Trends in disparities were analysed by including interaction terms in regressions between dummy variables for race/ethnic minority groups and period 2016-2017. Key Findings Disparities in MTM enrolment were detected between Blacks and Whites with diabetes in 2013-2014 (Odds Ratio = 0.78, 95% Confidence Interval = 0.75-0.81). This disparity improved from 2013-2014 to 2016-2017 for Blacks (Odds Ratio=1.08, 95% Confidence Interval = 1.04-1.11) but persisted in 2016-2017 (Odds Ratio = 0.84, 95% Confidence Interval = 0.81-0.87). A disparity was identified between Blacks and Whites with hypertension in 2013-2014 (Odds Ratio = 0.92, 95% Confidence Interval = 0.89-0.95) but not in 2016-2017. Enrolment for all groups, however, declined between periods. For example, in the total sample, the odds of enrolment declined from 2013-2014 to 2016-2017 by 22% (Odds Ratio=0.78, 95% Confidence Interval=0.75-0.81). Conclusions Racial disparities in MTM enrolment were found between Blacks and Whites among Medicare beneficiaries with diabetes in both periods and among individuals with hypertension in 2013-2014. As overall enrolment fell between periods, concerns about program enrolment remain.
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Affiliation(s)
- Joseph Garuccio
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - Chi Chun Steve Tsang
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, USA
| | - Ya Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, USA
- Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, USA
| | | | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism, USA
- Clinical Research Center, University of Tennessee College of Medicine, USA
| | - William C Cushman
- Department of Preventive Medicine, University of Tennessee College of Medicine, USA
| | - Xiaobei Dong
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - Jamie A Browning
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - Rose Zeng
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - Junling Wang
- Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
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Browning JA, Tsang CCS, Zeng R, Dong X, Garuccio J, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Wang J. Racial/ethnic disparities in the enrollment of Medication Therapy Management programs among Medicare beneficiaries with Alzheimer's disease and related dementias. Curr Med Res Opin 2022; 38:1715-1725. [PMID: 35852087 PMCID: PMC9529863 DOI: 10.1080/03007995.2022.2103962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Previous analysis of policy scenarios reported potential disparities in eligibility in the Medicare Medication Therapy Management (MTM) program. With recently released MTM data, this study aimed to determine if racial/ethnic disparities exist in MTM enrollment among Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD). METHODS Medicare claims/records (from 2013-2014 and 2016-2017) linked to the Area Health Resources File were examined. Included individuals were patients with ADRD and diabetes, hypertension or hyperlipidemia. The proportions of MTM enrollment were compared between non-Hispanic White (White) patients and racial/ethnic minority groups in descriptive analysis. Racial/ethnic disparities were then examined using a logistic regression adjusting for patient and community characteristics. Disparities across study periods were compared by estimating a logistic regression model with interaction terms between dummy variables for each racial/ethnic minority group and 2016-2017. RESULTS In unadjusted analyses, minorities had higher enrollment proportions than Whites. In 2016-2017, for example, enrollment percentages for Whites, Blacks, Hispanics, Asian/Pacific Islanders (Asians) and Others were respectively 14.44%, 16.71%, 19.83%, 16.66%, and 17.78%. In adjusted analyses, Blacks had lower enrollment odds than Whites within all cohorts. In the entire study sample in 2016-2017, for example, Blacks with ADRD had 9% lower odds of MTM enrollment (odds ratio 0.91, 95% confidence interval [CI] = 0.86-0.97) than Whites. These disparities decreased over time among the ADRD sample and all sub-groups. The interaction term between Blacks and 2016-2017, for instance, indicated that disparities were lowered by 11% (odds ratio 1.11, 95% CI = 1.05-1.16) across study periods among those with ADRD. CONCLUSIONS Blacks with ADRD, and diabetes, hypertension or hyperlipidemia have lower likelihood of MTM enrollment than Whites. Racial disparities were reduced over time but not eliminated.
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Affiliation(s)
- Jamie A. Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Rose Zeng
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Joseph Garuccio
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 N. Pauline, Memphis, TN 38163, United States
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Christopher K. Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jack W. Tsao
- Department of Neurology, University of Tennessee Health Science Center & Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, TN 38163, United States
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
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Lee M, Zarowitz BJ, Pellegrin K, Cooke CE, Fleming SP, Brandt N. Social determinants predict whether medicare beneficiaries are offered a Comprehensive Medication review. Res Social Adm Pharm 2022; 19:184-188. [DOI: 10.1016/j.sapharm.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022]
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Browning JA, Tsang CCS, Dong X, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Liu C, Wang J. Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer's Disease: an observational analysis. BMC Health Serv Res 2022; 22:159. [PMID: 35130899 PMCID: PMC8822650 DOI: 10.1186/s12913-022-07483-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. Conclusions Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.
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Affiliation(s)
- Jamie A Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA.
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN, 38163, USA
| | - Marie A Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Christopher K Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Jack W Tsao
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap St, Memphis, 38105, USA.,Department of Neurology, University of Tennessee Health Science Center College of Medicine, 855 Monroe Avenue, Memphis, TN, 38163, USA
| | - Colin Liu
- University of Pennsylvania College of Arts and Sciences, Philadelphia, PA, 19104, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
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Dong X, Tsang CCS, Zhao S, Wan JY, Shih YCT, Chisholm-Burns MA, Dagogo-Jack S, Cushman WC, Hines LE, Wang J. Effects of the Medicare Part D Comprehensive Medication Review on Racial and Ethnic Disparities in Medication Adherence. AMERICAN HEALTH & DRUG BENEFITS 2021; 14:101-109. [PMID: 35261713 PMCID: PMC8845523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/30/2021] [Indexed: 06/14/2023]
Abstract
Background Substantial research has documented inequalities between US minorities and whites in meeting the eligibility criteria for the Medicare Part D medication therapy management (MTM) program. Even though the Centers for Medicare & Medicaid Services attempted to relax the eligibility criteria, a critical barrier to effective MTM reform is a lack of stronger evidence about the effects of MTM on minorities' health outcomes. Objective To examine the effects of comprehensive medication review (CMR), an MTM core component, on racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years. Methods This study used full-year 2017 Medicare Parts A, B, and D claims data, including MTM data, linked to the Area Health Resources Files. Racial and ethnic disparities in nonadherence to diabetes, hypertension, and hyperlipidemia medications were compared between CMR recipients and nonrecipients matched by their propensity scores. To determine the changes in racial and ethnic disparities after receiving CMR, a difference-in-differences framework was applied, by including in logistic regression analyses interaction terms between dummy variables for CMR receipt and each racial or ethnic minority group. Results Compared with CMR nonrecipients, CMR recipients had significantly lower racial and ethnic disparities across the 3 outcome measures, with the exception of the difference between whites and blacks in nonadherence to diabetes medications. For example, compared with CMR nonrecipients, among CMR recipients the differences in the odds of nonadherence to hypertension medications were reduced, respectively, by 8% (95% confidence interval [CI], 0.88-0.96) between whites and blacks; by 18% (95% CI, 0.78-0.86) between whites and Hispanics; by 16% (95% CI, 0.77-0.91) between whites and Asians; and by 9% (95% CI, 0.85-0.98) between whites and other racial and ethnic groups. Conclusion Receiving a CMR reduced the racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years. These findings provide critical empirical evidence that may inform the future design of the Medicare Part D MTM program, which is valuable for improving pharmacotherapy outcomes and could further realize its potential when additional people from racial and ethnic minorities are enrolled.
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Patterns and predictors of older adult Medicare Part D beneficiaries' receipt of medication therapy management. Res Social Adm Pharm 2020; 16:1208-1214. [PMID: 31859225 PMCID: PMC9827433 DOI: 10.1016/j.sapharm.2019.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Medicare Part D medication therapy management (MTM) includes an annual comprehensive medication review (CMR) as a strategy to mitigate suboptimal medication use in older adults. OBJECTIVES To describe the characteristics of Medicare beneficiaries who were eligible, offered, and received a CMR in 2013 and 2014 and identify potential disparities. METHODS This nationally representative cross-sectional study used a 20% random sample of Medicare Part A, B, and D data linked with Part D MTM files. A total of 5,487,343 and 5,822,188 continuously enrolled beneficiaries were included in 2013 and 2014, respectively. CMR use was examined among a subset of 620,164 and 669,254 of these beneficiaries enrolled in the MTM program in 2013 and 2014. Main measures were MTM eligibility, CMR offer, and CMR receipt. The Andersen Behavioral Model of Health Services Use informed covariates selected. RESULTS In 2013 and 2014, 505,658 (82%) and 649,201 (97%) MTM eligible beneficiaries were offered a CMR, respectively. Among those, CMR receipt increased from 81,089 (16%) in 2013 to 119,181 (18%) in 2014. The mean age of CMR recipients was 75 years (±7) and the majority were women, White, and without low-income status. In 2014, lower odds of CMR receipt were associated with increasing age (adjusted odds ratio (OR) = 0.99 (95% confidence interval (CI) = 0.994-0.995), male sex (OR = 0.93, 95% CI = 0.926-0.951), being any non-White race/ethnicity except Black, dual-Medicaid status (OR = 0.64, 95% CI = 0.626-0.650), having a hospitalization (OR = 0.87, 95% CI = 0.839-0.893) or emergency department visit (OR = 0.67, 95% CI = 0.658-0.686), and number of comorbidities (OR = 0.90, 95% CI = 0.896-0.905). CONCLUSIONS CMR offers and completion rates have increased, but disparities in CMR receipt by age, sex, race, and dual-Medicaid status were evident. Changes to MTM targeting criteria and CMR offer strategies may be warranted to address disparities.
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Spivey CA, Qiao Y, Wang J, Shih YCT, Wan JY, Dagogo-Jack S, Cushman WC, Hines LE, Chisholm-Burns MA. Comparative Effectiveness of Medication Therapy Management Eligibility Criteria Across Racial/Ethnic Groups. J Am Geriatr Soc 2019; 67:581-587. [PMID: 30674080 DOI: 10.1111/jgs.15754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Previous research indicates that eligibility criteria for medication therapy management (MTM) services in Medicare prescription drug (Part D) plans, defined under the Medicare Modernization Act (MMA), are associated with racial/ethnic disparities and ineffective in identifying individuals with medication utilization issues. Our study's objective was to determine the comparative effectiveness of MTM eligibility criteria under MMA and in the Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial/ethnic groups. DESIGN ACA and MMA MTM eligibility criteria were compared on proportions of eligible individuals among patients with medication utilization issues. Multinomial logistic regression was conducted to control for patient/community characteristics. Need-based and demand-based analyses were used to determine disparities due to need and demand for healthcare. Main/sensitivity analyses were conducted for the range of eligibility thresholds. SETTING Medicare data (2012-2013) linked to Area Health Resources Files. PARTICIPANTS A total of 964 610 patients 65 years or older. MEASUREMENTS Medication safety/adherence measures, developed primarily by the Pharmacy Quality Alliance, were used to determine medication utilization issues. RESULTS Higher proportions of patients were eligible based on ACA than MMA MTM eligibility criteria. For example, in 2013, proportions based on ACA and MMA MTM eligibility criteria would be 99.7% and 26.2%, respectively, in the main analysis (p < .001); in the demand-based main analysis, ACA criteria were associated with 13.6% and 9.8%, respectively, higher effectiveness than MMA criteria among non-Hispanic blacks and Hispanics than non-Hispanic whites. CONCLUSION ACA MTM eligibility criteria are more effective than MMA criteria in identifying older patients needing MTM, particularly among minorities. J Am Geriatr Soc 67:581-587, 2019.
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Affiliation(s)
- Christina A Spivey
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, Memphis, Tennessee
| | - Yanru Qiao
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, Memphis, Tennessee
| | - Junling Wang
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, Memphis, Tennessee
| | - Ya-Chen Tina Shih
- Department of Health Services Research & Chief, Section of Cancer Economics and Policy, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, Tennessee
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism & Clinical Research Center, University of Tennessee College of Medicine, Memphis, Tennessee
| | - William C Cushman
- Department of Preventive Medicine and Medicine, University of Tennessee College of Medicine & Chief, Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, Tennessee
| | - Lisa E Hines
- Measure Operations & Analytics, Pharmacy Quality Alliance, Alexandria, Virginia
| | - Marie A Chisholm-Burns
- University of Tennessee College of Pharmacy, Memphis, Knoxville and Nashville, Tennessee
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Qiao Y, Spivey CA, Wang J, Shih YCT, Wan JY, Kuhle J, Dagogo-Jack S, Cushman WC, Chisholm-Burns M. Predictive Value Positive of MTM Eligibility Criteria under MMA and ACA in Identifying Individuals with Medication Utilization Issues. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018; 9:393-401. [PMID: 30906425 PMCID: PMC6426324 DOI: 10.1111/jphs.12266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the predictive value positives (PVP) of medication therapy management eligibility criteria under the Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying individuals with medication utilization issues (MUI). METHODS This is a retrospective analysis of Medicare database (2012-2013). MUI were determined based on medication utilization measures related to Medicare Part D Star Ratings. PVP or proportions of individuals with MUI were compared between individuals eligible for MTM under MMA and ACA. Need-based and demand-based logistic regression was used to adjust for patient characteristics. MTM eligibility thresholds in 2009 and 2013 and proposed 2015 MTM eligibility thresholds under MMA were examined. Main/sensitivity/disease-specific analyses were conducted to cover the range of eligibility thresholds and combinations. KEY FINDINGS MMA has higher PVP in identifying patients with MUI than ACA. Proportions of individuals with MUI were higher based on MMA than ACA (e.g., 74.96% for 2009 MMA, 73.51% for 2013 MMA, and 62.46% for proposed 2015 MMA vs. 52.17% for ACA in main analysis; P<0.05). Adjusted findings were similar. For example, based on the demand-based model in the main analysis, the odds ratios were 2.474 (95% CI: 2.454-2.494) for 2013 MMA in comparison to ACA. These numbers indicate that the MMA MTM eligibility criteria for 2013 had 147.4% higher PVP in identifying patients with MUI than ACA. Similar patterns were found in most sensitivity and disease-specific analyses. CONCLUSIONS MMA has higher PVP than ACA in identifying patients with MUI. This study may inform the government on future MTM policy.
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Affiliation(s)
- Yanru Qiao
- Health Outcomes and Policy Research, Department of Clinical Pharmacy & Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 212, Memphis, TN 38163, , ,
| | - Christina A Spivey
- Department of Clinical Pharmacy & Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 258, , ,
| | - Junling Wang
- Health Outcomes and Policy Research, Department of Clinical Pharmacy & Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 221, Memphis, TN 38163, , ,
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center & Chief, Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1444, Houston, TX 77030, , ,
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline, Suite 633, Memphis, TN 38163, , ,
| | - Julie Kuhle
- Pharmacy Quality Alliance, 5911 Kingstowne Village Parkway, Suite 130, Alexandria, Virginia 22315, , ,
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism & Director, Clinical Research Center, University of Tennessee Health Science Center, 920 Madison Avenue, Suite 300A, Memphis, TN 38163, , ,
| | - William C Cushman
- Department of Preventive Medicine and Medicine, University of Tennessee College of Medicine & Chief, Preventive Medicine Section, Veterans Affairs Medical Center, 1030 Jefferson Avenue, Room 5159, Memphis, TN 38104, , ,
| | - Marie Chisholm-Burns
- University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 264, Memphis, TN 38163, , ,
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Qiao Y, Spivey CA, Wang J, Shih YCT, Wan JY, Kuhle J, Dagogo-Jack S, Cushman WC, Chisholm-Burns MA. Higher Predictive Value Positive for MMA Than ACA MTM Eligibility Criteria Among Racial and Ethnic Minorities: An Observational Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2018; 55:46958018795749. [PMID: 30175638 PMCID: PMC6122237 DOI: 10.1177/0046958018795749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to examine positive predictive value (PPV) of medication therapy management (MTM) eligibility criteria under Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial and ethnic groups. The study analyzed Medicare data (2012-2013) for 2 213 594 beneficiaries. Medication utilization issues were determined based on medication utilization measures mostly developed by Pharmacy Quality Alliance. MMA was associated with higher PPV than ACA in identifying individuals with medication utilization issues among non-Hispanic blacks (blacks) and Hispanics than non-Hispanic whites (whites). For example, odds ratio for having medication utilization issues to whites when examining MMA in 2013 and ACA were 1.09 (95% confidence interval [CI] = 1.04-1.15) among blacks, and 1.17 (95% CI = 1.10-1.24) among Hispanics, in the main analysis. Therefore, MMA was associated with 9% and 17% higher PPV than ACA in identifying patients with medication utilization issues among blacks and Hispanics, respectively, than whites.
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Affiliation(s)
- Yanru Qiao
- 1 The University of Tennessee Health Science Center, Memphis, USA
| | | | - Junling Wang
- 1 The University of Tennessee Health Science Center, Memphis, USA
| | | | - Jim Y Wan
- 1 The University of Tennessee Health Science Center, Memphis, USA
| | - Julie Kuhle
- 3 Pharmacy Quality Alliance, Alexandria, VA, USA
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Spivey CA, Wang J, Qiao Y, Shih YCT, Wan JY, Kuhle J, Dagogo-Jack S, Cushman WC, Chisholm-Burns M. Racial and Ethnic Disparities in Meeting MTM Eligibility Criteria Based on Star Ratings Compared with the Medicare Modernization Act. J Manag Care Spec Pharm 2018; 24:97-107. [PMID: 29384031 PMCID: PMC5793919 DOI: 10.18553/jmcp.2018.24.2.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous research found racial and ethnic disparities in meeting medication therapy management (MTM) eligibility criteria implemented by the Centers for Medicare & Medicaid Services (CMS) in accordance with the Medicare Modernization Act (MMA). OBJECTIVE To examine whether alternative MTM eligibility criteria based on the CMS Part D star ratings quality evaluation system can reduce racial and ethnic disparities. METHODS This study analyzed the Beneficiary Summary File and claims files for Medicare beneficiaries linked to the Area Health Resource File. Three million Medicare beneficiaries with continuous Parts A, B, and D enrollment in 2012-2013 were included. Proposed star ratings criteria included 9 existing medication safety and adherence measures developed mostly by the Pharmacy Quality Alliance. Logistic regression and the Blinder-Oaxaca approach were used to test disparities in meeting MMA and star ratings eligibility criteria across racial and ethnic groups. Multinomial logistic regression was used to examine whether there was a disparity reduction by comparing individuals who were MTM-eligible under MMA but not under star ratings criteria and those who were MTM-eligible under star ratings criteria but not under the MMA. Concerning MMA-based MTM criteria, main and sensitivity analyses were performed to represent the entire range of the MMA eligibility thresholds reported by plans in 2009, 2013, and proposed by CMS in 2015. Regarding star ratings criteria, meeting any 1 of the 9 measures was examined as the main analysis, and various measure combinations were examined as the sensitivity analyses. RESULTS In the main analysis, adjusted odds ratios for non-Hispanic blacks (backs) and Hispanics to non-Hispanic whites (whites) were 1.394 (95% CI = 1.375-1.414) and 1.197 (95% CI = 1.176-1.218), respectively, under star ratings. Blacks were 39.4% and Hispanics were 19.7% more likely to be MTM-eligible than whites. Blacks and Hispanics were less likely to be MTM-eligible than whites in some sensitivity analyses. Disparities were not completely explained by differences in patient characteristics based on the Blinder-Oaxaca approach. The multinomial logistic regression of each main analysis found significant adjusted relative risk ratios (RRR) between whites and blacks for 2009 (RRR = 0.459, 95% CI = 0.438-0.481); 2013 (RRR = 0.449, 95% CI = 0.434-0.465); and 2015 (RRR = 0.436, 95% CI = 0.425-0.446) and between whites and Hispanics for 2009 (RRR = 0.559, 95% CI = 0.528-0.593); 2013 (RRR = 0.544, 95% CI = 0.521-0.569); and 2015 (RRR = 0.503, 95% CI = 0.488-0.518). These findings indicate a significant reduction in racial and ethnic disparities when using star ratings eligibility criteria; for example, black-white disparities in the likelihood of meeting MTM eligibility criteria were reduced by 55.1% based on star ratings compared with MMA in 2013. Similar patterns were found in most sensitivity and disease-specific analyses. CONCLUSIONS This study found that minorities were more likely than whites to be MTM-eligible under the star ratings criteria. In addition, MTM eligibility criteria based on star ratings would reduce racial and ethnic disparities associated with MMA in the general Medicare population and those with specific chronic conditions. DISCLOSURES Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number R01AG049696. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Cushman reports an Eli Lilly grant and uncompensated consulting for Takeda Pharmaceuticals outside this work. The other authors have no potential conflicts of interest to report. Study concept and design were contributed by Wang and Shih, along with Wan, Kuhle, Spivey, and Cushman. Wang, Qiao, and Wan took the lead in data collection, with assistance from the other authors. Data interpretation was performed by Wang, Kuhle, and Qiao, with assistance from the other authors. The manuscript was written by Spivey and Qiao, along with the other authors, and revised by Cushman, Dagogo-Jack, and Chisholm-Burns, along with the other authors.
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Affiliation(s)
| | - Junling Wang
- 1 University of Tennessee College of Pharmacy, Memphis
| | - Yanru Qiao
- 1 University of Tennessee College of Pharmacy, Memphis
| | | | - Jim Y Wan
- 3 University of Tennessee Health Science Center College of Medicine, Memphis
| | - Julie Kuhle
- 4 Pharmacy Quality Alliance, Alexandria, Virginia
| | - Samuel Dagogo-Jack
- 3 University of Tennessee Health Science Center College of Medicine, Memphis
| | - William C Cushman
- 5 University of Tennessee Health Science Center College of Medicine and Veterans Affairs Medical Center, Memphis, Tennessee
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