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Examining Medicare Part D Medication Therapy Management program in the context of mental health

Published:December 21, 2019DOI:https://doi.org/10.1016/j.japh.2019.12.008

      Abstract

      Objectives

      To describe and compare the delivery of medication therapy management (MTM) between Medicare beneficiaries with and without mental health conditions.

      Design

      Nationally representative cross-sectional study that used a 20% random sample of 2014 Medicare Parts A, B, and D data merged with a 100% sample of 2014 MTM data.

      Setting and participants

      Medicare beneficiaries continuously enrolled in Parts A, B, and D in 2014 were included in this study. Comprehensive medication review (CMR) use and MTM delivery were examined among a subset of 825,003 MTM-enrolled beneficiaries.

      Outcome measures

      Predisposing, enabling, and need characteristics were selected on the basis of the Andersen Behavioral Model of Health Services Use. Descriptive, bivariable, and multivariable logistic regression statistics were used to determine associations between beneficiary characteristics and MTM delivery.

      Results

      A total of 3,016,620 (43%) and 3,997,105 beneficiaries (57%) were categorized into mental health and nonmental health cohorts, respectively. MTM enrollment in the mental health cohort was significantly higher than that in the nonmental health cohort (17.4% vs. 7.5%, P < 0.001). However, once enrolled, a greater proportion of beneficiaries in the nonmental health cohort received CMRs (19.3% vs. 17.7%, P < 0.001). Patients in the mental health cohort were more likely to have hospitalization (22% vs. 9.2%, P < 0.001) or emergency department visit (25.2% vs. 11.5%, P < 0.001) and used more medications in 2014 (16 % vs. 12%, P < 0.001). The proportion of patients in the mental health cohort receiving a CMR in 2014 that had at least 1 medication-related problem (MRP) identified and resolved was higher than that of patients in the nonmental health cohort (24.8% vs. 20.6%, P < 0.001).

      Conclusion

      Although patients with mental health conditions are more often enrolled into MTM, they are less likely to receive a CMR once enrolled. Given that this population has higher medical complexity and a higher MRP burden following a CMR, opportunities exist for pharmacists to enhance MTM delivery in this population.
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      Biography

      Meena N. Murugappan, PharmD, MPH, Research Associate and PhD Student, Social & Administrative Pharmacy, University of Minnesota College of Pharmacy, Minneapolis, MN

      Biography

      Randall D. Seifert, PharmD, Professor, Associate Dean for Student and Professional Affairs, and Co-Director for Center for Leading Healthcare Change, University of Minnesota College of Pharmacy, Minneapolis, MN

      Biography

      Joel F. Farley, PhD, FAPhA, Professor and Peters Endowed Chair in Pharmacy Practice Innovation, Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN