Predictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues

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Abstract

Objectives: To compare the predictive value positives (PVP) of medication therapy management eligibility criteria under the Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying individuals with medication utilization issues (MUI). Methods: This is a retrospective analysis of Medicare database (2012–2013). MUI were determined based on medication utilization measures related to Medicare Part D Star Ratings. PVP or proportions of individuals with MUI were compared between individuals eligible for medication therapy management (MTM) under MMA and ACA. Need-based and demand-based logistic regression was used to adjust for patient characteristics. MTM eligibility thresholds in 2009 and 2013 and proposed 2015 MTM eligibility thresholds under MMA were examined. Main/sensitivity/disease-specific analyses were conducted to cover the range of eligibility thresholds and combinations. Key Findings: MMA has higher PVP in identifying patients with MUI than ACA. Proportions of individuals with MUI were higher based on MMA than ACA (e.g. 74.96% for 2009 MMA, 73.51% for 2013 MMA, and 62.46% for proposed 2015 MMA vs. 52.17% for ACA in main analysis; P < 0.05). Adjusted findings were similar. For example, based on the demand-based model in the main analysis, the odds ratios were 2.474 (95% CI: 2.454–2.494) for 2013 MMA in comparison to ACA. These numbers indicate that the MMA MTM eligibility criteria for 2013 had 147.4% higher PVP in identifying patients with MUI than ACA. Similar patterns were found in most sensitivity and disease-specific analyses. Conclusions: MMA has higher PVP than ACA in identifying patients with MUI. This study may inform the government on future MTM policy.

Original languageEnglish (US)
Pages (from-to)393-401
Number of pages9
JournalJournal of Pharmaceutical Health Services Research
Volume9
Issue number4
DOIs
StatePublished - Dec 1 2018

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Medication Therapy Management
Patient Protection and Affordable Care Act
Medicare
Social Change
Modernization
Therapy
Medication
Medicare Part D

All Science Journal Classification (ASJC) codes

  • Economics, Econometrics and Finance (miscellaneous)
  • Pharmacology, Toxicology and Pharmaceutics (miscellaneous)

Cite this

@article{605edf0b8cfc410a8b21b0bcb5084ad2,
title = "Predictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues",
abstract = "Objectives: To compare the predictive value positives (PVP) of medication therapy management eligibility criteria under the Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying individuals with medication utilization issues (MUI). Methods: This is a retrospective analysis of Medicare database (2012–2013). MUI were determined based on medication utilization measures related to Medicare Part D Star Ratings. PVP or proportions of individuals with MUI were compared between individuals eligible for medication therapy management (MTM) under MMA and ACA. Need-based and demand-based logistic regression was used to adjust for patient characteristics. MTM eligibility thresholds in 2009 and 2013 and proposed 2015 MTM eligibility thresholds under MMA were examined. Main/sensitivity/disease-specific analyses were conducted to cover the range of eligibility thresholds and combinations. Key Findings: MMA has higher PVP in identifying patients with MUI than ACA. Proportions of individuals with MUI were higher based on MMA than ACA (e.g. 74.96{\%} for 2009 MMA, 73.51{\%} for 2013 MMA, and 62.46{\%} for proposed 2015 MMA vs. 52.17{\%} for ACA in main analysis; P < 0.05). Adjusted findings were similar. For example, based on the demand-based model in the main analysis, the odds ratios were 2.474 (95{\%} CI: 2.454–2.494) for 2013 MMA in comparison to ACA. These numbers indicate that the MMA MTM eligibility criteria for 2013 had 147.4{\%} higher PVP in identifying patients with MUI than ACA. Similar patterns were found in most sensitivity and disease-specific analyses. Conclusions: MMA has higher PVP than ACA in identifying patients with MUI. This study may inform the government on future MTM policy.",
author = "Yanru Qiao and Christina Spivey and Junling Wang and Shih, {Ya Chen Tina} and Jim Wan and Julie Kuhle and Samuel Dagogo-Jack and William Cushman and Marie Chisholm-Burns",
year = "2018",
month = "12",
day = "1",
doi = "10.1111/jphs.12266",
language = "English (US)",
volume = "9",
pages = "393--401",
journal = "Journal of Pharmaceutical Health Services Research",
issn = "1759-8885",
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}

TY - JOUR

T1 - Predictive value positive of MTM eligibility criteria under MMA and ACA in identifying individuals with medication utilization issues

AU - Qiao, Yanru

AU - Spivey, Christina

AU - Wang, Junling

AU - Shih, Ya Chen Tina

AU - Wan, Jim

AU - Kuhle, Julie

AU - Dagogo-Jack, Samuel

AU - Cushman, William

AU - Chisholm-Burns, Marie

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objectives: To compare the predictive value positives (PVP) of medication therapy management eligibility criteria under the Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying individuals with medication utilization issues (MUI). Methods: This is a retrospective analysis of Medicare database (2012–2013). MUI were determined based on medication utilization measures related to Medicare Part D Star Ratings. PVP or proportions of individuals with MUI were compared between individuals eligible for medication therapy management (MTM) under MMA and ACA. Need-based and demand-based logistic regression was used to adjust for patient characteristics. MTM eligibility thresholds in 2009 and 2013 and proposed 2015 MTM eligibility thresholds under MMA were examined. Main/sensitivity/disease-specific analyses were conducted to cover the range of eligibility thresholds and combinations. Key Findings: MMA has higher PVP in identifying patients with MUI than ACA. Proportions of individuals with MUI were higher based on MMA than ACA (e.g. 74.96% for 2009 MMA, 73.51% for 2013 MMA, and 62.46% for proposed 2015 MMA vs. 52.17% for ACA in main analysis; P < 0.05). Adjusted findings were similar. For example, based on the demand-based model in the main analysis, the odds ratios were 2.474 (95% CI: 2.454–2.494) for 2013 MMA in comparison to ACA. These numbers indicate that the MMA MTM eligibility criteria for 2013 had 147.4% higher PVP in identifying patients with MUI than ACA. Similar patterns were found in most sensitivity and disease-specific analyses. Conclusions: MMA has higher PVP than ACA in identifying patients with MUI. This study may inform the government on future MTM policy.

AB - Objectives: To compare the predictive value positives (PVP) of medication therapy management eligibility criteria under the Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying individuals with medication utilization issues (MUI). Methods: This is a retrospective analysis of Medicare database (2012–2013). MUI were determined based on medication utilization measures related to Medicare Part D Star Ratings. PVP or proportions of individuals with MUI were compared between individuals eligible for medication therapy management (MTM) under MMA and ACA. Need-based and demand-based logistic regression was used to adjust for patient characteristics. MTM eligibility thresholds in 2009 and 2013 and proposed 2015 MTM eligibility thresholds under MMA were examined. Main/sensitivity/disease-specific analyses were conducted to cover the range of eligibility thresholds and combinations. Key Findings: MMA has higher PVP in identifying patients with MUI than ACA. Proportions of individuals with MUI were higher based on MMA than ACA (e.g. 74.96% for 2009 MMA, 73.51% for 2013 MMA, and 62.46% for proposed 2015 MMA vs. 52.17% for ACA in main analysis; P < 0.05). Adjusted findings were similar. For example, based on the demand-based model in the main analysis, the odds ratios were 2.474 (95% CI: 2.454–2.494) for 2013 MMA in comparison to ACA. These numbers indicate that the MMA MTM eligibility criteria for 2013 had 147.4% higher PVP in identifying patients with MUI than ACA. Similar patterns were found in most sensitivity and disease-specific analyses. Conclusions: MMA has higher PVP than ACA in identifying patients with MUI. This study may inform the government on future MTM policy.

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U2 - 10.1111/jphs.12266

DO - 10.1111/jphs.12266

M3 - Article

VL - 9

SP - 393

EP - 401

JO - Journal of Pharmaceutical Health Services Research

JF - Journal of Pharmaceutical Health Services Research

SN - 1759-8885

IS - 4

ER -