Comprehensive Medication Review Completion Rates and Disparities after Medicare Star Rating Measure

Importance: Comprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourage the use of CMRs. Objective: To examine trends in CMR completion rates before and after 2016 and whether racial, ethnic, and socioeconomic disparities in CMR completion changed. Design, Setting, and Participants: This observational study using interrupted time-series analysis examined 2013 to 2020 annual cohorts of community-dwelling Medicare beneficiaries aged 66 years and older eligible for a CMR as determined by Part D plans and by objective minimum eligibility criteria. Data analysis was conducted from September 2022 to February 2024. Exposure: Adoption of CMR completion as a Star Rating quality measure in 2016. Main Outcome and Measures: CMR completion modeled via generalized estimating equations. Results: The study included a total of 561950 eligible beneficiaries, with 253561 in the 2013 to 2015 cohort (median [IQR] age, 75.8 [70.7-82.1] years; 90778 male [35.8%]; 6795 Asian [2.7%]; 24425 Black [9.6%]; 7674 Hispanic [3.0%]; 208621 White [82.3%]) and 308389 in the 2016 to 2020 cohort (median [IQR] age, 75.1 [70.4-80.9] years; 126730 male [41.1%]; 8922 Asian [2.9%]; 27915 Black [9.1%]; 7635 Hispanic [2.5%]; 252781 White [82.0%]). The unadjusted CMR completion rate increased from 10.2% (7379 of 72225 individuals) in 2013 to 15.6% (14185 of 90847 individuals) in 2015 and increased further to 35.8% (18376 of 51386 individuals) in 2020, in part because the population deemed by Part D plans to be MTM-eligible decreased by nearly half after 2015 (90487 individuals in 2015 to 51386 individuals in 2020). Among a simulated cohort based on Medicare minimum eligibility thresholds, the unadjusted CMR completion rate increased but to a lesser extent, from 4.4% in 2013 to 12.6% in 2020. Compared with White beneficiaries, Asian and Hispanic beneficiaries experienced greater increases in likelihood of CMR completion after 2016 but remained less likely to complete a CMR. Dual-Medicaid enrollees also experienced greater increases in likelihood of CMR completion as compared with those without either designation, but still remained less likely to complete CMR. Conclusion and Relevance: This study found that adoption of CMR completion as a Star Rating quality measure was associated with higher CMR completion rates. The increase in CMR completion rates was achieved partly because Part D plans used stricter eligibility criteria to define eligible patients. Reductions in disparities for eligible Asian, Hispanic, and dual-Medicaid enrollees were seen, but not eliminated. These findings suggest that quality measures can inform plan behavior and could be used to help address disparities..