Health Implications of the MTM Eligibility Criteria In The Affordable Care Act Across Racial And Ethnic Groups

Wang, J.; Qiao, Yanru; Shih, Y.C.T.; Jamison, J.J.; Spivey, Christina A.; Wan, Jim Y.; White‐Means, Shelley I.; Dagogo‐Jack, Samuel; Cushman, William C.; Chisholm-Burns, Marie A.

doi:10.1016/j.jval.2014.08.426

Cited by 4 publications

(18 citation statements)

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“…For example, Wang et al . reported lower likelihood of MTM eligibility among minorities than Whites under the MMA and ACA MTM eligibility criteria . Future research may need to consider other alternative MTM eligibility criteria.…”

Section: Discussionmentioning

confidence: 96%

“…Previous studies have documented the shortcomings of the MMA MTM eligibility criteria and emphasized the importance of modifying the design of MTM programs to increase accessibility and benefit individuals who most need MTM services . Wang et al .…”

Section: Introductionmentioning

confidence: 99%

“…Wang et al . reported a series of findings on racial and ethnic disparity implications of the MMA MTM eligibility criteria . Stuart et al .…”

Section: Introductionmentioning

confidence: 99%

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Predictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues

Qiao

Spivey

Wang

et al. 2018

J Pharm Health Serv Res

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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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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Predictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues

Qiao

Spivey

Wang

et al. 2018

J Pharm Health Serv Res

View full text Add to dashboard Cite

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“…Minorities, in particular, could benefit from MTM services because they are more likely than non‐Hispanic whites (whites) to have certain chronic conditions (eg, diabetes, hypertension) targeted by MTM and are more likely to have medication utilization issues . However, previous studies documented racial/ethnic inequities in MTM eligibility because eligibility criteria are predominantly utilization based, and racial/ethnic minorities typically use fewer prescription medications and incur lower prescription medication costs than whites …”

mentioning

confidence: 99%

“…The 2010 Affordable Care Act (ACA) laid out the following criteria to target patients for MTM in demonstration programs: (1) taking four or more prescribed medications; (2) taking any “high‐risk” medications; (3) having two or more chronic diseases; or (4) having undergone a transition of care or other factors likely to cause medication utilization issues . Wang et al found that the MTM eligibility rate based on ACA MTM eligibility criteria could exceed 80% if applied to Part D enrollees . This is mainly because patients must only meet one eligibility criterion under ACA, whereas MMA requires patients to meet all eligibility criteria.…”

mentioning

confidence: 99%

Comparative Effectiveness of Medication Therapy Management Eligibility Criteria Across Racial/Ethnic Groups

Spivey

Qiao

Wang

et al. 2019

J American Geriatrics Society

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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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Racial and ethnic disparities in the enrolment of medicare medication therapy management programs

Garuccio

Tsang

Wan

et al. 2023

Journal of Pharmaceutical Health Services Research

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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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Health Implications of the MTM Eligibility Criteria In The Affordable Care Act Across Racial And Ethnic Groups

Cited by 4 publications

References 0 publications

Predictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues

Predictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues

Comparative Effectiveness of Medication Therapy Management Eligibility Criteria Across Racial/Ethnic Groups

Racial and ethnic disparities in the enrolment of medicare medication therapy management programs

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