Online Program

Evaluation of Clinical and Financial Outcomes in a Medication Therapy Management Program in a Publicly Insured Adult Population

Tuesday, November 3, 2015 : 2:30 p.m. - 2:50 p.m.

Henry Carretta, PhD MPH, Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallhassee, FL
Tiffany Schleeter, M.S., FSU College of Medicine, Florida State University, Tallahassee, FL
Danisha Baker, MS, College of Medicine, Florida State University, Tallahassee, FL
Charles Saunders, PhD, College of Medicine, Florida State University, Tallahassee, FL
Mike Smith, MA, College of Medicine, Florida State University, Tallahassee, FL
Leslie Beitsch, MD, JD, College of Medicine, Florida State University, Tallahassee, FL
The current literature on MTM suggests that many patients receiving MTM counseling see improved health outcomes that include:  1) better medication adherence, 2) reduced exposure to potential drug-drug or drug-disease interactions, 3) reduced instances of over or under medication, and 3) better control of their conditions as reflected by fewer inpatient hospitalizations and visits to the ED.  Payers have reportedly observed lower medical and prescription drug reimbursements for populations that receive an MTM intervention.  The majority of the published literature evaluating MTM programs was conducted on populations of working age adults covered by private insurance.

 The purpose of this project was to evaluate the effectiveness of an MTM intervention in minimizing expenditures and reducing inpatient hospital admissions and outpatient emergency department visits in a disabled working-age (21-64 years) adult population eligible for Medicaid via a Section 1115 Waiver from the Centers for Medicare & Medicaid Services.  A MTM program was chosen as the required demonstration project for this waiver.

 We used two fundamental approaches to construct comparison groups and to adjust statistically for remaining differences between the intervention and comparison group.   The pool for CG members included anyone from the MEG3 population that had not received the MTM intervention. 

Method 1 relied on careful editing of the pool of MTM-P and potential CG members to remove any observed enrolled days which should have been excluded.  The MTM-P and CG constructed with Method 1 was then analyzed using a difference-in-difference (DiD) models to control for baseline differences in the four outcomes of interest.  Although the sign on the DiD coefficient was often negative, indicating improved outcomes in the MTM-P intervention group, across of all of the models, none of the coefficients was statistically significant. 

Method 2 used propensity score matching to explicitly choose a distinct CG for each outcome measure.  The CG was selected based on age, sex, length of enrollment, and ACG morbidity score and an average treatment effect was computed.  The results were consistent with Method 1, there was no statistically significant difference between the MTM-P and CG across any of the four outcomes.

Positive results for MTM interventions have been widely published MTM evaluative literature is still in its infancy.  More research is needed to determine its effectiveness in a Medicaid population.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Discuss the findings for the evaluation of the Florida Medicaid Medication Therapy Management Program

Keyword(s): Underserved Populations, Chronic Disease Management and Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: 20 years of progressive experience in public health and health services research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.