Characteristics of Older Adults Who Meet the Annual Prescription Drug Expenditure Threshold for Medicare Medication Therapy Management Programs

Daniel, Gregory W.; Malone, Daniel C.

doi:10.18553/jmcp.2007.13.2.142

Cited by 34 publications

(45 citation statements)

References 39 publications

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“…The calculation of the number of chronic conditions is conducted based on a raw count of chronic conditions among a list compiled by Daniel and Malone that includes all applicable conditions that the MTM programs can target. 40 The diagnosis of the chronic conditions was based on the Clinical Classification Codes in Medical Conditions File.…”

Section: Methodsmentioning

confidence: 99%

Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma

Qiao

Johnson

et al. 2016

Journal of Asthma

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Background Asthma is one of the most frequently targeted chronic diseases in the medication therapy management (MTM) programs of the Medicare prescription drug (Part D) benefits. While racial and ethnic disparities in meeting eligibility criteria for MTM services have been reported, little is known about whether there would be similar disparities among adults with asthma in the United States. Methods Adult patients with asthma (age ≥18) from Medical Expenditure Panel Survey (2011–2012) were analyzed. Bivariate analyses were conducted to compare the proportions of patients who would meet Medicare MTM eligibility criteria between Whites and minority groups (Blacks and Hispanics). Survey-weighted logistic regression was performed to adjust for patient characteristics. Main and sensitivity analyses were conducted to cover the entire range of the eligibility thresholds used by Part D plans in 2011–2012. Results The sample included 4,455 patients with asthma, including 2,294 non-Hispanic Whites (Whites), 1,218 non-Hispanic Blacks (Blacks), and 943 Hispanics. Blacks and Hispanics had lower proportions of meeting MTM eligibility criteria than did Whites (P <0.001). According to the main analysis adjusting for patient characteristics, Blacks and Hispanics had 36% and 32% lower, respectively, likelihood of MTM eligibility than Whites (odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.45–0.90; OR: 0.68, 95% CI: 0.47–0.98, respectively). Similar results were obtained in sensitivity analyses. Conclusions There are racial and ethnic disparities in meeting Medicare Part D MTM eligibility criteria among adult patients with asthma. Future studies should examine the implications of such disparities on health outcomes of patients with asthma and explore alternative MTM eligibility criteria.

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Section: Methodsmentioning

confidence: 99%

Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma

Qiao

Johnson

et al. 2016

Journal of Asthma

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“…This list of chronic conditions was developed by Daniel and Malone and consisted of those chronic conditions that are applicable to Medicare beneficiaries. 36 The list of medical conditions was based on clinical classification codes developed in MEPS by aggregating ICD-9 codes. 33 Each of the clinical classification codes represents a clinical classification category; for example, code “005” is HIV infection and “202” is for rheumatoid arthritis and related diseases.…”

Section: Methodsmentioning

confidence: 99%

Racial and ethnic disparities in influenza vaccinations among community pharmacy patients and non-community pharmacy respondents

Wang

Munshi

Hong

2014

Research in Social and Administrative Pharmacy

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Background Since 2009, pharmacists in all 50 states in the U.S. have been authorized to administer vaccinations. Objectives This study examined racial and ethnic disparities in the reported receipt of influenza vaccinations within the past year among noninstitutionalized community pharmacy patients and non-community pharmacy respondents. Methods The 2009 Medical Expenditure Panel Survey was analyzed. The sample consisted of respondents aged 50 years or older, as per the 2009 recommendations by the Advisory Committee on Immunization Practices. Bivariate and multivariate logistic regression analyses were conducted to examine the influenza vaccination rates and disparities in receiving influenza vaccinations within past year between non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks) and Hispanics. The influenza vaccination rates between community pharmacy patients and non-community pharmacy respondents were also examined. Results Bivariate analyses found that among the community pharmacy patients, a greater proportion of Whites reported receiving influenza vaccinations compared to Blacks (60.9% vs. 49.1%; P < 0.0001) and Hispanics (60.9% vs. 51.7%; P < 0.0001). Among non-community pharmacy respondents, differences also were observed in reported influenza vaccination rates among Whites compared to Blacks (41.0% vs. 24.3%; P < 0.0001) and Hispanics (41.0% vs. 26.0%; P < 0.0001). Adjusted logistic regression analyses found significant racial disparities between Blacks and Whites in receiving influenza vaccinations within the past year among both community pharmacy patients (odds ratio [OR]: 0.81; 95% CI: 0.69–0.95) and non-community pharmacy respondents (OR: 0.66; 95% CI: 0.46–0.94). Sociodemographic characteristics and health status accounted for the disparities between Hispanics and Whites. Overall, community pharmacy patients reported higher influenza vaccination rates compared to non-community pharmacy respondents (59.0% vs. 37.2%; P < 0.0001). Conclusion Although influenza vaccination rates were higher among community pharmacy patients, there were racial disparities in receiving influenza vaccinations among both community pharmacy patients and non-community pharmacy respondents. Increased emphasis on educational campaigns among pharmacists and their patients, especially minorities, may be needed.

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“…16 For "have 2 or more chronic diseases" criterion, a list of chronic conditions applicable to the Medicare population assembled by Daniel and Malone was applied. 17 Chronic conditions for each participant were identified using a free tool developed by the Agency for Healthcare Research & Quality, Clinical Classification Software (CCS), which aggregates medical conditions and illnesses into 285 mutually exclusive categories. 18 When determining "a transition of care or “other factors,” because the study sample comprised of only community-dwelling Medicare beneficiary, any record of a hospitalization, hospice, or admission to any other facility including nursing home was considered as a transition of care.…”

Section: Methodsmentioning

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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Characteristics of Older Adults Who Meet the Annual Prescription Drug Expenditure Threshold for Medicare Medication Therapy Management Programs

Cited by 34 publications

References 39 publications

Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma

Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma

Racial and ethnic disparities in influenza vaccinations among community pharmacy patients and non-community pharmacy respondents

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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