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MEDICATION THERAPY MANAGEMENT

Assessment of the Impact of Medication Therapy Management Delivered to Home-Based Medicare Beneficiaries

Clinical Pharmacy Specialist, Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO

Thomas Delate, PhD MS

Clinical Pharmacy Research Scientist, Pharmacy Department, Kaiser Permanente Colorado; Clinical Instructor, School of Pharmacy, University of Colorado Denver, Aurora

Elizabeth A Chester, PharmD MPH BCPS

Senior Director, Quality and Clinical Pharmacy Services, Pharmacy Department, Kaiser Permanente Colorado; Clinical Assistant Professor, School of Pharmacy, University of Colorado Denver

Troy Stubbings, PharmD

Chief, Clinical Pharmacy Call Center, Pharmacy Department, Kaiser Permanente Colorado

Reprints: Dr. Delate, 16601 E. Centretech Pkwy., Aurora, CO 80011, fax 303/739-3574, tom.delate{at}kp.org

BACKGROUND: Medication Therapy Management (MTM) is a voluntary patient participation program mandated for Medicare Part D sponsors by the Centers for Medicare and Medicaid Services for chronically ill beneficiaries with high medication costs/utilization.

OBJECTIVE: To assess the impact of an MTM program on mortality, healthcare utilization, and prescription medication costs and to quantify drug-related problems (DRPs) identified during MTM.

METHODS: This nonrandomized controlled study was conducted among beneficiaries who were targeted for MTM in 2006. The MTM intervention was designed to identify potential DRPs, educate the patient/caregiver about appropriate medication use, and ensure that the patient was appropriately integrated into clinical services. Data were collected from administrative databases and manual chart abstractions. Study outcomes included all-cause death (primary outcome), hospitalization, and emergency department (ED) visit rates and medication cost changes in the 180 days following MTM targeting and quantification of DRPs. Multivariate logistic regression was used to adjust the outcomes for baseline risk and other potential confounders. A mock MTM intervention was performed for beneficiaries who declined MTM and died, were hospitalized, and/or made an ED visit.

RESULTS: A total of 459 opt-in and 336 opt-out beneficiaries who agreed and declined, respectively, to receive MTM were included in the analysis. Beneficiaries who opted in were less likely to die compared with beneficiaries who opted out (adjusted OR [AOR] 0.5; 95% CI 0.3 to 0.9) but were more likely to have had a hospitalization (AOR 1.4; 95% CI 1.1 to 2.0) and an increase in medication costs (AOR 1.4; 95% CI 1.1 to 1.9) during follow-up. There was no difference in ED visit rates. At least one DRP was identified in more than 83% of beneficiaries in both groups, with the most common DRP being drug-drug interaction.

CONCLUSIONS: Our investigation supports the use of MTM, with its increased coordination of information between healthcare providers and patients, since it may impact mortality positively in a population of high-risk Medicare beneficiaries.

Key Words: health services administration, Medicare Part D, Medication Therapy Management, pharmacy

Published Online, March 24, 2009. www.theannals.com, DOI 10.1345/aph.1L524