Social determinants predict whether Medicare beneficiaries are offered a Comprehensive Medication Review

Lee, Merton; Zarowitz, Barbara J.; Pellegrin, Karen L.; Cooke, Catherine E.; Fleming, Sean; Brandt, Nicole

doi:10.1016/j.sapharm.2022.09.015

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…Asian and Hispanic beneficiaries’ completion rates did increase more than White beneficiaries over time, but overall remained lower, indicating that disparities were not eliminated and suggesting the need for additional strategies. Prior studies 10 , 11 have also found that low-income beneficiaries were less likely to be offered a CMR, as well as complete a CMR if offered. Aligned with these prior findings, we saw that dual-Medicaid enrollees were less likely to receive a CMR and that prior to the Star Rating measure in 2016, dual-Medicaid enrollees and LIS-only enrollees had slower CMR completion growth rates.…”

Section: Discussionmentioning

confidence: 94%

“…8 , 9 Each Part D plan then sets their own MTM eligibility criteria based on these thresholds to determine to whom they offer a CMR. Prior studies 10 , 11 have examined patient characteristics associated with offer and completion of a CMR in 2013 to 2016 as well as racial, ethnic, and socioeconomic disparities in Medicare minimum thresholds for MTM eligibility criteria. 12 , 13 , 14 Specifically, Black and Hispanic beneficiaries were found to be less likely to meet Medicare minimum thresholds for MTM eligibility criteria, 12 , 13 , 14 and low-income beneficiaries were less likely to be offered a CMR, as well as complete a CMR, if offered.…”

Section: Introductionmentioning

confidence: 99%

“… 12 , 13 , 14 Specifically, Black and Hispanic beneficiaries were found to be less likely to meet Medicare minimum thresholds for MTM eligibility criteria, 12 , 13 , 14 and low-income beneficiaries were less likely to be offered a CMR, as well as complete a CMR, if offered. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

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Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure

Hung,

Wilson,

Smith

et al. 2024

JAMA Health Forum

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ImportanceComprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourage the use of CMRs.ObjectiveTo examine trends in CMR completion rates before and after 2016 and whether racial, ethnic, and socioeconomic disparities in CMR completion changed.Design, Setting, and ParticipantsThis observational study using interrupted time-series analysis examined 2013 to 2020 annual cohorts of community-dwelling Medicare beneficiaries aged 66 years and older eligible for a CMR as determined by Part D plans and by objective minimum eligibility criteria. Data analysis was conducted from September 2022 to February 2024.ExposureAdoption of CMR completion as a Star Rating quality measure in 2016.Main Outcome and MeasuresCMR completion modeled via generalized estimating equations.ResultsThe study included a total of 561 950 eligible beneficiaries, with 253 561 in the 2013 to 2015 cohort (median [IQR] age, 75.8 [70.7-82.1] years; 90 778 male [35.8%]; 6795 Asian [2.7%]; 24 425 Black [9.6%]; 7674 Hispanic [3.0%]; 208 621 White [82.3%]) and 308 389 in the 2016 to 2020 cohort (median [IQR] age, 75.1 [70.4-80.9] years; 126 730 male [41.1%]; 8922 Asian [2.9%]; 27 915 Black [9.1%]; 7635 Hispanic [2.5%]; 252 781 White [82.0%]). The unadjusted CMR completion rate increased from 10.2% (7379 of 72 225 individuals) in 2013 to 15.6% (14 185 of 90 847 individuals) in 2015 and increased further to 35.8% (18 376 of 51 386 individuals) in 2020, in part because the population deemed by Part D plans to be MTM-eligible decreased by nearly half after 2015 (90 487 individuals in 2015 to 51 386 individuals in 2020). Among a simulated cohort based on Medicare minimum eligibility thresholds, the unadjusted CMR completion rate increased but to a lesser extent, from 4.4% in 2013 to 12.6% in 2020. Compared with White beneficiaries, Asian and Hispanic beneficiaries experienced greater increases in likelihood of CMR completion after 2016 but remained less likely to complete a CMR. Dual-Medicaid enrollees also experienced greater increases in likelihood of CMR completion as compared with those without either designation, but still remained less likely to complete CMR.Conclusion and RelevanceThis study found that adoption of CMR completion as a Star Rating quality measure was associated with higher CMR completion rates. The increase in CMR completion rates was achieved partly because Part D plans used stricter eligibility criteria to define eligible patients. Reductions in disparities for eligible Asian, Hispanic, and dual-Medicaid enrollees were seen, but not eliminated. These findings suggest that quality measures can inform plan behavior and could be used to help address disparities.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure

Hung,

Wilson,

Smith

et al. 2024

JAMA Health Forum

View full text Add to dashboard Cite

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“…Such inequities in medication-related experiences and outcomes can occur in any stage of the medication use process, such as the prescription, dispensing and administration of medication, and a sample of these issues is presented in Table 2. The available evidence suggests that members of ethnic minority groups [4,5,[15][16][17][18][19][20], people who are institutionalised [17,21], incarcerated [22,23] or homeless [24][25][26] and people of sexual minority groups [27] are more likely to experience medication-related problems than the general population. This is also true for people with certain health statuses, such as those with sensory impairment, either auditory or visual [17,28], older people with intellectual disabilities [29] and those who experience cognitive impairment, severe mental illness and frailty [17].…”

Section: Do Marginalised Groups Experience the Same Medication-relate...mentioning

confidence: 99%

“…Racial, ethnic or linguistic minority [4,5,[15][16][17][18][19][20] Patient's differing culture, beliefs, religious practices and perceptions about health and the impact of treatment on their decisions about medication use.…”

Section: Racial Ethnic or Linguistic Minoritymentioning

confidence: 99%

Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care

et al. 2023

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Marginalised people experience diminished access to pharmaceutical care and worse medication-related outcomes than the general population. Health equity is a global priority. This article explores the key evidence of health inequity and medication use, structures the causes and contributory factors and suggests opportunities that can be taken to advance the pharmaceutical care agenda so as to achieve health equity. The causes of, and contributors to, this inequity are multi-fold, with patient- and person-related factors being the most commonly reported. Limited evidence is available to identify risk factors related to other aspects of a personal medication use system, such as technology, tasks, tools and the internal and the external environments. Multiple opportunities exist to enhance equity in medication-related outcomes through pharmaceutical care research and practice. To optimise the effects and the sustainable implementation of these opportunities, it is important to (1) ensure the meaningful inclusion and engagement of members of marginalised groups, (2) use a person-centred approach and (3) apply a systems-based approach to address all of the necessary components of a system that interact and form a network as work processes that produce system outcomes.

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Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries

Hung,

Wilson,

Smith

et al. 2024

J American Geriatrics Society

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BackgroundThe use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive medication review (CMR) to all beneficiaries who qualify, and provides a platform to reduce PIM use. The objective of this study was to assess the impact of CMR on PIM discontinuation in Medicare beneficiaries and whether this differed by race or ethnicity.MethodsRetrospective cohort study of community‐dwelling Medicare Part D beneficiaries ≥66 years of age who were eligible for MTM from 2013 to 2019 based on 5% Medicare fee‐for‐service claims data linked to the 100% MTM data file. Among those using a PIM, MTM‐eligible CMR recipients were matched to non‐recipients via sequential stratification. The probability of PIM discontinuation was estimated using regression models that pooled yearly subcohorts accounting for within‐beneficiary correlations. The most common PIMs that were discontinued after CMR were reported.ResultsWe matched 24,368 CMR recipients to 24,368 CMR non‐recipients during the observation period. Median age was 74–75, 35% were males, most were White beneficiaries (86%–87%), and the median number of PIMs was 1. In adjusted analyses, CMR receipt was positively associated with PIM discontinuation (adjusted relative risk [aRR]: 1.26, 95% CI: 1.20–1.32). There was no evidence of differential impact of CMR by race or ethnicity. The PIMs most commonly discontinued after CMR were glimepiride, zolpidem, digoxin, amitriptyline, and nitrofurantoin.ConclusionsAmong Medicare beneficiaries who are using a PIM, CMR receipt was associated with PIM discontinuation, suggesting that greater CMR use could facilitate PIM reduction for all racial and ethnic groups.

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Social determinants predict whether Medicare beneficiaries are offered a Comprehensive Medication Review

Cited by 5 publications

References 19 publications

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure

Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries

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