Historical trend of disparity implications of Medicare MTM eligibility criteria

Wang, Junling; Qiao, Yanru

doi:10.1016/j.sapharm.2012.09.003

Cited by 16 publications

(19 citation statements)

References 22 publications

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“…This study's findings concerning disparities follow patterns similar to those identified in prior research, as summarized in Table . It was previously reported that according to 2006 MTM eligibility thresholds (the most restrictive since MTM implementation), the adjusted odds ratios for meeting eligibility criteria for blacks and Hispanics compared to whites were 0.36–0.60 ( P <0.05) and 0.13–0.46 ( P <0.05) respectively .…”

Section: Discussionsupporting

confidence: 87%

“…To date, participation rates for MTM programmes have never exceeded 15% . Additionally, MTM eligibility criteria are implicated in racial and ethnic disparities in receiving MTM services . Non‐Hispanic blacks (blacks) and Hispanics may be less likely to meet MTM eligibility criteria because said criteria are predominantly based on prescription drug utilization, and these minorities typically use fewer prescription drugs and incur lower drug costs compared to their non‐Hispanic white (white) counterparts …”

Section: Introductionmentioning

confidence: 99%

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Disparity implications of proposed 2015 Medicare eligibility criteria for medication therapy management services

Wang

Qiao

Spivey

et al. 2016

J Pharm Health Serv Res

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Objectives Previous studies found that racial and ethnic minorities may be less likely than non-Hispanic Whites (Whites) to meet existing Medicare medication therapy management (MTM) eligibility criteria. To address these issues, the Centers for Medicare & Medicaid Services (CMS) proposed alternative Medicare MTM eligibility criteria for 2015. Due to opposition to other Part D reforms proposed simultaneously by various stakeholders, CMS rescinded all proposed reforms. This study was conducted to determine whether non-Hispanic Blacks (Blacks) and Hispanics have lower likelihood of meeting the proposed 2015 Medicare MTM eligibility criteria. Methods This retrospective observational analysis used Medical Expenditure Panel Survey data (2010-2011). The final study sample was comprised of 2,721 Whites (weighted to 37,185,896), 917 Blacks (weighted to 4,665,644), and 538 Hispanics (weighted to 3,532,882). Chi-square tests were used to examine racial and ethnic disparities in meeting proposed 2015 MTM eligibility criteria and each component of proposed 2015 MTM eligibility criteria. In multivariate analysis, a logistic regression model was used to control for population socio-demographic and health-related characteristics. Key Findings Compared to Whites with a proportion of MTM eligibility of 58.82%, the eligible proportion was 57.09% (P=0.20) for Blacks, and 48.97% (P<0.0001) for Hispanics, respectively. According to multivariate logistic regression, odds ratios of meeting MTM eligibility for Blacks and Hispanics compared to Whites were 0.74 (95% Confidence Internal [CI] = 0.62-0.88) and 0.53 (95% CI=0.43-0.67), respectively. Conclusions The proposed 2015 MTM eligibility criteria would not eliminate racial and ethnic disparities in MTM eligibility. Alternative MTM eligibility criteria should be devised.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Disparity implications of proposed 2015 Medicare eligibility criteria for medication therapy management services

Wang

Qiao

Spivey

et al. 2016

J Pharm Health Serv Res

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“…11,12 However, previous research has reported that Blacks and Hispanics would be less likely to meet the Medicare eligibility criteria for MTM services. 9,13,14 For example, a study by Wang et al using historical data reported that the adjusted odds ratios for meeting MTM eligibility criteria for Blacks and Hispanics to Whites ranged from 0.36 to 0.60 ( P < .05) and 0.13 to 0.46 ( P < .05), respectively, according to 2006 eligibility criteria. 9 Similar results were found using the 2010 eligibility thresholds.…”

Section: Introductionmentioning

confidence: 99%

Potential health implications of racial and ethnic disparities in meeting MTM eligibility criteria

Wang

Qiao

Shih

et al. 2014

Research in Social and Administrative Pharmacy

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Background Previous studies have found that racial and ethnic minorities would be less likely to meet the Medicare eligibility criteria for medication therapy management (MTM) services than their non-Hispanic White counterparts. Objectives To examine whether racial and ethnic disparities in health status, health services utilization and costs, and medication utilization patterns among MTM-ineligible individuals differed from MTM-eligible individuals. Methods This study analyzed Medicare beneficiaries in 2004–2005 Medicare Current Beneficiary Survey. Various multivariate regressions were employed depending on the nature of dependent variables. Interaction terms between the dummy variables for Blacks (and Hispanics) and MTM eligibility were included to test whether disparity patterns varied between MTM-ineligible and MTM-eligible individuals. Main and sensitivity analyses were conducted for MTM eligibility thresholds for 2006 and 2010. Results Based on the main analysis for 2006 MTM eligibility criteria, the proportions for self-reported good health status for Whites and Blacks were 82.82% vs. 70.75%, respectively (difference=12.07%; P< .001), among MTM-ineligible population; and 56.98% vs. 52.14%, respectively (difference=4.84%; P= .31), among MTM-eligible population. The difference between these differences was 7.23% (P< .001). In the adjusted logistic regression, the interaction effect for Blacks and MTM eligibility had an OR of 1.57 (95% Confidence Interval, or CI=0.98–2.52) on multiplicative term and difference in odds of 2.38 (95% CI=1.54–3.22) on additive term. Analyses for disparities between Whites and Hispanics found similar disparity patterns. All analyses for 2006 and 2010 eligibility criteria generally reported similar patterns. Analyses of other measures did not find greater racial or ethnic disparities among the MTM-ineligible than MTM-eligible individuals. Conclusions Disparities in MTM eligibility may aggravate existing racial and ethnic disparities in health outcomes. However, disparities in MTM eligibility may not aggravate existing disparities in health services utilization and costs and medication utilization patterns. Future studies should examine the effects of Medicare Part D on these disparities.

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“…Additionally, the same group of researchers suggested aligning MTM eligibility with a metric such as “potentially preventable future costs,” with the purpose of reducing spending and improving quality of care. 36 In January 2014, CMS proposed a new set of rules for Part D plans, acknowledging the limitations of the current MTM eligibility criteria including those reported by Wang et al 8,9,37 CMS proposed to expand MTM to all individuals who have at least two chronic conditions, have two Part D-covered drugs, and exceed a drug cost threshold of $620.40. Further research is needed to confirm that the proposed criteria will have the desired effects of increasing access to MTM services among Medicare beneficiaries and decreasing racial and ethnic disparities.…”

Section: Discussionmentioning

confidence: 99%

“…3 Wang et al has found that under the MTM eligibility criteria set forth in the MMA Non-Hispanic Blacks (Blacks) and Hispanics may be less likely to be eligible for MTM services than Non-Hispanic Whites (Whites) among the Medicare population according to current Medicare MTM eligibility criteria. 8,9 This is because the Medicare MTM eligibility criteria are predominantly based on medication utilization and costs, while Blacks and Hispanics tend to use fewer prescription medications and incur lower prescription medication costs. 3,10,11 Further, Wang et al found that existing Medicare MTM eligibility criteria may aggravate, rather than remediate, racial and ethnic disparities in health status.…”

Section: Introductionmentioning

confidence: 99%

Potential Health Implications of Medication Therapy Management Eligibility Criteria in the Patient Protection and Affordable Care Act Across Racial and Ethnic Groups

Wang¹,

Qiao²,

Shih³

et al. 2015

JMCP

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Background The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) requires Part D plans to establish programs to provide medication therapy management (MTM) services starting from 2006. MTM services have been found to improve patient outcomes from pharmacotherapy, reduce emergency room visits and hospitalizations, and reduce health care costs in a cost-effective fashion. However, previous research found that Non-Hispanic Blacks (Blacks) and Hispanics may be less likely to be eligible for MTM services than Non-Hispanic Whites (Whites) among the Medicare population according to current Medicare MTM eligibility criteria. This is because the Medicare MTM eligibility criteria are predominantly based on medication utilization and costs, while Blacks and Hispanics tend to use fewer prescription medications and incur lower prescription medication costs. The Patient Protection and Affordable Care Act (PPACA) laid out a set of MTM eligibility criteria for eligible entities to target patients for MTM services: “(1) take 4 or more prescribed medications …; (2) take any ‘high risk’ medications; (3) have 2 or more chronic diseases… or (4) have undergone a transition of care, or other factors… that are likely to create a high risk of medication-related problems.” Objectives This study aimed to examine (1) racial/ethnic disparities in meeting the eligibility criteria for MTM services in PPACA among the Medicare population; and (2) whether there would be greater disparities in health and economic outcomes among MTM-ineligible than MTM-eligible groups. (If so, the PPACA MTM eligibility criteria may aggravate existing disparities.) Methods This was a retrospective cross-sectional analysis of Medicare Current Beneficiaries Survey (MCBS; 2007–2008). To determine medication characteristics, the Food and Drug Administration’s Electronic Orange Book was also used. Proportions of population eligible for MTM services based on the PPACA MTM eligibility criteria were compared across racial and ethnic groups using a chi-square test; a logistic regression model was used to adjust for population socio-demographic and health characteristics. Health and economic outcomes examined included health status (self-perceived good health status, number of chronic diseases, activities of daily living or ADLs, and instrumental activities of daily living or IADLs), health services utilization and costs (physician visits, emergency room visits, and total health care costs), and medication utilization patterns (generic dispensing ratio). To determine difference in disparities across MTM eligibility categories, difference-in-differences regressions of various functional forms were employed depending on the nature of the dependent variables. Interaction terms between the dummy variables for minority groups (e.g., Blacks or Hispanics) and MTM eligibility were included to test whether disparity patterns varied between MTM-ineligible and MTM-eligible individuals. Results The sample consisted of 12,966 Medicare beneficiaries, of which 11,...

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Historical trend of disparity implications of Medicare MTM eligibility criteria

Cited by 16 publications

References 22 publications

Disparity implications of proposed 2015 Medicare eligibility criteria for medication therapy management services

Disparity implications of proposed 2015 Medicare eligibility criteria for medication therapy management services

Potential health implications of racial and ethnic disparities in meeting MTM eligibility criteria

Potential Health Implications of Medication Therapy Management Eligibility Criteria in the Patient Protection and Affordable Care Act Across Racial and Ethnic Groups

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