(1168) Association Between Receipt of Comprehensive Medication Review and Healthcare Utilization in Older Adult Medicare Part D Beneficiaries

Objectives: In the Medicare Part D medication therapy management (MTM) program, Medicare plans are required to offer an annual comprehensive medication review (CMR) to patients meeting eligibility criteria. CMRs represent the most comprehensive service under the MTM and involve a review of a patient’s medications, identification and resolution of medication related problems (MRPs), development of an individualized treatment plan and follow up with patients. Despite its launch in 2006, evidence of the benefits of the MTM program are conflicting and there have been few studies examining the impact of the program on a large generalizable population of Medicare beneficiaries. This study examined the effectiveness of receiving a CMR on intensive healthcare utilization including emergency department (ED) visits and inpatient hospital admissions.

Methods: We linked 100% Medicare MTM data files with inpatient, outpatient, prescription claims, and enrollment information among a 20% random sample of Medicare beneficiaries for years 2013 through 2019. Patients were included in the study if they were at least 65 years old, continuously enrolled in Part A, B and D, enrolled in MTM program, met target criteria for MTM per CMS's Part D requirements and got offer to receive a CMR between January 1, 2013 and December 31, 2019. Patients with disabilities were excluded. The intervention group comprised patients who newly received a CMR with no prior evidence of a CMR in the past year. The control group consisted of MTM patients who were offered a CMR but did not receive a CMR visit. Comparisons between CMR recipients and the control group were made over a one-year pre-period to a one-year post-period from the index date representing the date of CMR receipt or date of a CMR offer respectively. A difference-in-difference (DID) model was used to compare changes in ED visits and hospital admissions between the pre- and post-index periods among CMR recipients compared to non-recipients. Greedy neighbor 1:1 propensity matching by numerous covariates including patient demographics, socioeconomic status, comorbidities, and Medicare enrollment type was used to improve cohort comparability.

Results: After applying eligibility criteria, 533,550 observations were in the intervention group and 1,413,860 observations in the control group. After matching, 531,314 intervention and 531,314 control observations remained for analysis. Compared to the control group, the risks of any ED visits within three months, six months and one year before the index date were 34% (risk ratio (RR)=0.66, 95% CI=0.65-0.67), 29% (RR=0.71, 95% CI=0.70-0.72) and 18% (RR=0.82, 95% CI=0.81-0.82) lower, and after the index date were 29% (RR=0.71, 95% CI=0.70 - 0.72), 26% (RR=0.74, 95% CI=0.73 - 0.75) and 21% (RR=0.79, 95% CI=0.78 - 0.79) lower in the intervention group. The risks of any hospital visits within three months, six months and one year before the index date were 39% (RR=0.61, 95% CI=0.59-0.62), 31% (RR)= 0.69, 95% CI=0.68-0.70) and 15% (RR=0.85, 95% CI=0.84-0.85) lower, and after the index date were 35% (RR=0.65, 95% CI=0.64-0.66), 32% (RR=0.68, 95% CI=0.67-0.69) and 21% (RR=0.73, 95% CI=0.72-0.74) lower in the intervention group. The DID analysis shows that the absolute risks of ED visits and hospital admissions from the pre- to the post-index period of one year were significantly lower (DID of ED visits risk = -0.49%, 95% CI= -0.64% – -0.33% and DID for hospitalization=-1.72%, 95% CI= -1.88% – -1.57%) in intervention group.

Conclusions: Although CMR exposure was associated with decreased risks of ED visits and hospital admissions from the pre- to post-index period of one year in older Medicare beneficiaries, the results lack significant clinical benefit. Future research should consider the mode of delivering CMRs as well as the impact of the program among high-risk cohorts when examining benefits in reducing high-intensity healthcare utilization.