Earlier this month the Journal of the American Pharmacist Association published a comparison of medication therapy management (MTM) between Medicare beneficiaries with and without mental health conditions.
The Study Design
The study, Examining Medicare Part D Medication Therapy Management program in the context of mental health (Murugappan et.al.), used a random national sample of 2014 Medicare Parts A, B and D claims merged with 2014 MTM data. To be included in the study the claims had to be associated with Medicare beneficiaries who were continuously enrolled in Parts A, B, and D in 2014. The final sample consisted of 825,003 MTM eligible beneficiaries and the authors studied comprehensive medication review (CMR) and MTM delivery.
The authors analyzed the data using a combination of descriptive statistics and logistic regression to look for correlations between characteristics of beneficiaries and MTM delivery.
The study divided Medicare beneficiaries into mental health and non-mental health cohorts. The authors found 3,016,620 (43%) mental health beneficiaries and 3,997,105 (57%) non-mental health beneficiaries.
Finding 1. MTM enrollment of mental health beneficiaries was significantly higher than that of non-mental health beneficiaries (17.4% vs. 7.5%, P < 0.001).
Finding 2. Once enrolled, a greater proportion of beneficiaries in the non-mental health cohort received CMRs (19.3% vs. 17.7%, P < 0.001).
Finding 3. Mental health beneficiaries were more likely to experience a hospitalization (22% vs. 9.2%, P < 0.001) or emergency room visit (25.2% vs. 11.5%, P < 0.001) and used more medications (16 % vs. 12%, P < 0.001).
Finding 4. The proportion beneficiaries with at least 1 drug related problem (DRP) that was identified and resolved was higher in the mental health beneficiaries (24.8% vs. 20.6%, P < 0.001).
In general the authors found that while beneficiaries with a mental health problem qualify for MTM more often they receive MTM services less. The authors found that beneficiaries with mental health disorders were higher users of acute care services and might benefit more profoundly from MTM services. The literature has demonstrated for instance the correlation between low mental health medication adherence and increased use of acute care services. Finally, the authors concluded that the larger medication regimen burden provided more opportunity for MTM clinicians to intervene and close therapy gaps.
MTM Program Insights
CSS Health Take-Away. At CSS the large majority of our plans shoot for 5 STAR CMR rates. This study would indicate that MTM eligible members with mental health issues respond less to traditional CMR acquisition techniques. An MTM program that hopes to be high performing from a CMR acquisition perspective might need to focus on CMR engagment techniques that resonate with this subset of members.
CSS Health Take-Away. The enhanced MTM program is providing the opportunity for select prescription drug programs (PDPs) to experiment with components of MTM program design, including disease focused MTM. Studies such as this demonstrate the potential benefits of focusing on specific subsets of Medicare beneficiaries with specific disorders. Frequently, we encounter MTM program managers who want to focus on members who might benefit from specialized MTM services, but feel bound by the “constraints” of the standard MTM program design. However, even in the traditional Medicare Part D MTM program, CMS encourages providing enhanced services to subsets of the MTM eligible population who might benefit more. At CSS Health we encourage this also, allowing you to subset your MTM eligible population into various cohorts – Diabetes, CKD, Mental Health and provide enhanced interventions.
As always I am happy to discuss any aspect of medication management and approaches to better patient engagement and quality measure improvement.
Best – Jim
James Notaro, RPh, PhD
Founder and Chief Clinical Officer