Health care utilization and spending following comprehensive medication review in Medicare part D

Background: The Medicare Part D medication therapy management (MTM) program provides comprehensive medication reviews (CMRs) to eligible patients. Despite its introduction in 2006, benefits of the MTM program are still not well understood, lacking research in large generalizable Medicare populations. Objectives: To examine the effectiveness of receiving a CMR on health care utilizations and associated spending. Methods: A new user retrospective cohort study was used to compare changes in healthcare utilization and spending in CMR recipients to a matched cohort of Medicare beneficiaries who were eligible, but did not receive a CMR. Linking MTM files to inpatient, outpatient, and prescription claims for a 20% random sample of Medicare beneficiaries aged 65 and older, we obtained 533,550 CMR recipients and 1,413,860 non-recipients, and a propensity score matched sample of 531,314 CMR recipients and 531,314 nonrecipients. Difference-in-difference models were used to compare the 1-year probability and number of emergency department (ED) and hospital visits, and inpatient, outpatient, and prescription and total health spending between CMR recipients and nonrecipients. Results: Relative to CMR nonrecipients and the year prior to CMR delivery, CMR recipients experienced a 0.49% (95% confidence interval [CI], 0.33% to 0.64%%) and 1.72% (95% CI, 1.57% to 1.88%) lower probability of an ED visit and hospitalization 1 year after CMR delivery, respectively. Similarly, CMR receipt resulted in a reduction of 80 hospital stays (95% CI, 45 to 115) and 337 ED visits (95% CI, 305 to 370) per 10,000 recipients, respectively. Per beneficiary, non-prescription medical spending declined by $378 (95% CI = 314 to $442) while prescription spending increased by $470 (95% CI = $436 to $503) resulting in an additional $91 in total spending (95% CI = $20 to $164) among recipients. Conclusion: Health care utilization reduction associated with CMR, found in this study, suggests that CMR in older adults may help reduce nonprescription health care expenditure in the year following CMR.