PHS83 - Comparative Effectiveness of Mtm Eligibility Criteria Under ACA and Mma Across Racial and Ethnic Groups in Medicare

Abstract

To examine the comparative effectiveness of the Medicare medication therapy management (MTM) eligibility criteria under Patient Protection and Affordable Care Act (ACA) and Medicare Modernization Act (MMA) in identifying patients with medication utilization issues (MUI) across racial/ethnic groups in Medicare. This study analyzed Medicare data (2012-2013) linked to Area Health Resource Files. MUI were defined based on medication utilization measures used in Medicare Part D Star Ratings. MTM eligibility criteria under ACA, and MTM eligibility thresholds in 2009, 2013, and proposed 2015 MTM eligibility criteria under MMA were analyzed. Multinomial logistic regression was used to analyze the comparative effectiveness of ACA and MMA MTM eligibility criteria across racial/ethnic groups. The study controlled for patient characteristics at both individual and community/county levels. Main/sensitivity analyses were conducted to cover the ranges of eligibility thresholds and combinations. Higher likelihood of and lower racial/ethnic disparities in MTM eligibility were found under ACA than MMA. For example, in the main analysis for 2013, 74.50% more patients met MTM eligibility criteria under ACA than MMA (P<0.0001). Disparities between non-Hispanic Blacks (Blacks) and Hispanics versus non-Hispanic Whites (Whites) were 2.47% and 1.79%, respectively, lower under ACA than MMA (P<0.05 for both). Adjusted relative risk ratio (RRR) for Blacks versus Whites was 0.69 (95% Confidence Interval (CI)=0.67-0.70), indicating that the ACA MTM eligibility criteria were 31% more effective compared to those under MMA among Blacks vs. Whites. The same RRR was 0.79 (95% CI=0.76-0.81) for Hispanics/Whites. Similar patterns were found in all unadjusted/adjusted sensitivity analyses. The ACA MTM eligibility criteria were more effective than those under MMA and were also more comparatively effective among racial/ethnic minorities than Whites. Although the future of ACA is uncertain, ACA-based MTM eligibility criteria provide an alternative to MMA-based MTM eligibility criteria in improving effectiveness of MTM eligibility.