Finding Equitable and Effective MTM Eligibility Criteria

 描述(由申请人提供)：最近，当联邦医疗保险和医疗补助服务中心(CMS)发布了针对D部分计划的拟议2015年规则时，改善处方药(D部分)福利中药物治疗管理(MTM)服务的联邦医疗保险资格标准的必要性得到了强调。在这份文件中，CMS归功于我们团队关于当前MTM资格标准在以下方面的差异影响的一系列发现 更改MTM资格的原因。2006年，CMS根据《医疗保险现代化法案》(MMA)将MTM服务作为D部分的一部分实施，将药物审查和治疗计划结合在一起，并已被证明显著改善了药物治疗结果。MTM服务早就该提供了，因为与毒品有关的发病率/死亡率是一个由来已久且代价高昂的公共卫生问题，尤其是在老年人中。然而，正如我们所展示的，联邦医疗保险MTM资格标准是造成差异的制度化原因：MTM资格的药物使用/成本基础意味着种族和少数族裔不太可能符合条件，因为考虑到相同的健康状况，黑人和拉美裔往往比白人使用更少的药物/产生更低的药物成本。最近提出的2015年MTM资格标准只是降低了MMA法定框架内的药物使用/费用门槛，因此不太可能解决这些差异。此外，最近发现MMA MTM资格标准在捕获药物不依从性等次优治疗问题方面无效。该项目的目标是通过寻找公平和有效的MTM资格标准来解决这些问题。“有效性对于实现多边贸易管理的潜力至关重要，而”机会平等“是政策文件中使用最广泛的公平定义。具体目标1：测试我们根据CMS Part D星级系统中的药物安全/依从性措施提出的星级标准是否可以减少MTM资格中的种族和民族差异。具体目标2：比较《患者保护和平价医疗法案》(ACA)下的MTM资格标准和MMA在确定有药物利用问题的患者方面的有效性。我们将在敏感度、特异度、预测值(阳性/阴性)和受试者操作特征曲线上对它们进行比较。CMS认识到，分析ACA MTM资格标准很重要，因为这些标准将药物利用问题纳入MMA MTM资格框架。具体目标3：审查ACA和MMA下的MTM资格标准在确定跨种族和族裔群体的药物利用问题方面的比较有效性。我们还将检查差异的预测因素。 并进行针对疾病的分析。我们将使用链接到A部分和B部分索赔的2013 Medicare Part D数据、主受益人摘要文件和区域卫生资源文件。这个项目成功的可能性很大，因为我们的试点数据表明，少数族裔和白人一样有可能达到星级标准。国家老龄问题研究所将医疗保险受益人之间的差异/药物利用问题确定为资金优先事项。

 DESCRIPTION (provided by applicant): The need to improve the Medicare eligibility criteria for medication therapy management (MTM) services in prescription drug (Part D) benefits has been highlighted recently when the Centers for Medicare and Medicaid Services (CMS) released their proposed 2015 rules for Part D plans. In this document, CMS credited our team's series of findings on disparity implications of the current MTM eligibility criteria among the main reasons to change MTM eligibility. Combining medication review and treatment planning, MTM services were implemented by CMS in 2006 as a part of Part D based on the Medicare Modernization Act (MMA) and have been shown to significantly improve pharmacotherapy outcomes. MTM services are long overdue because drug-related morbidity/mortality is an age-old and costly public health problem, particularly among the elderly. However, as we have shown, Medicare MTM eligibility criteria are an institutionalized cause for disparities: the drug use/cost basis of MTM eligibility means that racial and ethnic minorities are less likely to qualif because, given the same health status, Blacks and Hispanics tend to use fewer drugs/incur lower drug costs than Whites. The recently proposed 2015 MTM eligibility criteria merely lower the drug use/cost thresholds within MMA statutory framework, and, thus, are unlikely to address these disparities. Moreover, MMA MTM eligibility criteria recently were found ineffective in capturing suboptimal-therapy problems such as drug nonadherence. The goal of this project is to address these issues by finding equitable and effective MTM eligibility criteria. "Effectiveness is essential for realizing MTM's potential, and "equality of access" is the most widely- used definition of equity in policy documents. Specific Aim 1: To test whether using Star Ratings criteria, which we propose based on the medication safety/adherence measures in the CMS Part D Star Ratings system, can reduce racial and ethnic disparities in MTM eligibility. Specific Aim 2: To compare the effectiveness of the MTM eligibility criteria under the Patient Protection and Affordable Care Act (ACA) and MMA in identifying patients with medication utilization issues. We will compare them on sensitivity, specificity, predictive values (positive/negative), and the receiver operating characteristic curves. ACA MTM eligibility criteria are important to analyze, as recognized by CMS, because these criteria incorporate medication utilization issues within the MMA MTM eligibility framework. Specific Aim 3: To examine the comparative effectiveness of the MTM eligibility criteria under ACA and MMA in identifying medication utilization issues across racial and ethnic groups. We will also examine predictors for disparities and conduct disease-specific analyses. We will use 2013 Medicare Part D data linked to Parts A and B claims, the Master Beneficiary Summary File, and the Area Health Resource File. This project's success is highly likely because our pilot data suggest that minorities may be as likely as Whites to meet the Star Ratings Criteria. The National Institute on Aging identifies disparities/medication utilization issues among Medicare beneficiaries as a funding priority.