Equity and Economic Effects of MTM Services

与毒品有关的发病率和死亡率每年给美国造成超过1774亿美元的损失，尤其是 在老年人中令人望而生畏。为了改善药物治疗结果并降低成本，美国疾病控制与预防中心 Medicare和Medicaid Services(CMS)建立了药物管理治疗(MTM)计划，作为 2006年医疗保险处方药福利(D部分)。遗憾的是，MTM注册人数已降至CMS以下 目标主要是由于MTM方案设计中的问题。此外，根据我们之前的政策情景分析， MTM资格标准主要由NIA R01支持，对种族/族裔少数群体可能过于严格， 可能会延续健康结果中的种族/民族差异，因为MTM资格是基于对 少数族裔倾向于较少使用的药物。CMS试图放松MTM资格门槛，理由是我们的 研究，但潜在的差距仍然与利用为基础的资格标准。一个严重的障碍 有效的MTM改革是缺乏关于MTM对少数民族的实际影响的更强有力的信息 结果、少数群体对MTM的利用以及MTM的成本效益。我们将填补这一知识空白 通过我们利用最新可用的MTM数据进行的拟议研究。我们的长期目标是改善健康 通过提高药物利用率和减少种族/民族，改善老年人在不同人群中的地位 药物利用和健康结果方面的差异。我们将分析Medicare Parts A/B/D数据(2015- 2016)，链接到区域卫生资源文件。我们的预期结果包括以下方面的新信息：(1)影响 关于药物利用、保健服务利用/费用和死亡率方面的种族/族裔差异的MTM； (2)MTM利用的衡量标准，如MTM交付方法，表现出不同的模式；和(3)成本- 从医疗保险和卫生系统的角度看MTM的有效性。我们将测量用药情况 利用循证的他汀类药物处方和其他主要由药房开发的措施 质量联盟，并被星级评级采用，这是一种与CMS奖金挂钩的健康计划-质量评估系统 对D部分计划的付款。服务利用率/费用包括医生就诊、急诊室就诊、 和住院(例如，因门诊护理敏感情况而住院)。我们会申请 多元回归模型、差分策略和负收益回归模型 使用频数和贝叶斯方法。目标1：检验MTM计划已减少的假设 在药物利用质量、保健服务利用和费用方面存在种族/族裔差异。目标2：测试 认为非西班牙裔黑人和西班牙裔得到的MTM服务比白人少且延迟的假设。 目的3：检验MTM是一个成本效益高的项目的假设。影响：我们的结果将提供更多- 需要经验证据来指导CMS制定MTM政策，并帮助NIA/NIH实现其战略目标 为“政策决策”提供信息，并“了解”健康差距并制定改善策略 不同人群中老年人的健康状况。

Drug-related morbidity and mortality cost the United States over $177.4 billion annually and are especially daunting among the elderly. To improve pharmacotherapy outcomes and reduce costs, the Centers for Medicare & Medicaid Services (CMS) established medication management therapy (MTM) programs as part of the Medicare prescription drug benefits (Part D) in 2006. Unfortunately, MTM enrollment has fallen below CMS targets mainly due to issues in MTM program design. Further, based on our previous policy scenario analysis, primarily supported by an NIA R01, MTM eligibility criteria may be too restrictive for racial/ethnic minorities and may perpetuate racial/ethnic disparities in health outcomes, because MTM eligibility is based on utilization of medications, which minorities tend to use less. CMS attempted to relax MTM eligibility thresholds, citing our research, but potential disparities remain with the utilization-based eligibility criteria. A critical barrier to effective MTM reform is the lack of stronger information about the actual effects of MTM on minorities' outcomes, utilization of MTM by minorities, and the cost-effectiveness of MTM. We will fill this knowledge gap through our proposed research with newly available MTM data. Our long-term goal is to improve the health status of older adults among diverse populations by improving medication utilization and reducing racial/ethnic disparities in medication utilization and health outcomes. We will analyze Medicare Parts A/B/D data (2015- 2016), linked to Area Health Resources Files. Our expected outcomes include new information on: (1) effects of MTM on racial/ethnic disparities in medication utilization, utilization/costs of health services, and mortality; (2) measures of MTM utilization, such as MTM delivery methods, that exhibit disparity patterns; and (3) cost- effectiveness of MTM from the perspectives of Medicare and health system. We will measure medication utilization using evidence-based statin prescribing and other measures primarily developed by Pharmacy Quality Alliance and adopted by Star Ratings, a health-plan-quality evaluation system tied to CMS bonus payments to Part D plans. Utilization/costs of services include those of physician visits, emergency room visits, and hospitalizations (e.g., hospitalizations originating from ambulatory care sensitive conditions). We will apply multivariate regression models, a difference-in-difference strategy and negative benefit regression models using frequentist and Bayesian approaches. Aim 1: Test the hypothesis that MTM programs have reduced racial/ethnic disparities in quality of medication utilization, and health services utilization and costs. Aim 2: Test the hypothesis that non-Hispanic Blacks and Hispanics receive fewer and delayed MTM services than Whites. Aim 3: Test the hypothesis that MTM is a cost-effective program. Impact: Our results will provide much- needed empirical evidence to guide MTM policy-making by CMS, and assist the NIA/NIH in its strategic goals of informing “policy decisions” and “understand(ing) health disparities and develop(ing) strategies to improve the health status of older adults in diverse populations.”