A medication therapy management program's impact on low-density lipoprotein cholesterol goal attainment in Medicare Part D patients with diabetes.
OBJECTIVE
To determine a medication therapy management (MTM) service's impact on (1) Healthcare Effectiveness Data and Information Set (HEDIS) quality measures and (2) use and cost expenditures.


METHODS
Nonequivalent group, quasiexperimental study.


METHODS
Florida, January 1, 2006, through September 30, 2007.


METHODS
2,114 Florida Health Care Plans Medicare Part D enrollees with diabetes.


METHODS
Intervention group participated in the MTM program during the HEDIS measurement year.


METHODS
Presence of low-density lipoprotein cholesterol (LDL-C) screening, LDL-C values, and LDL-C control (<100 mg/dL). The use measure was the total number of 30-day medication equivalents. Cost measures were (1) total Medicare Part D drug cost, (2) enrollees' out-of-pocket Part D medication costs, and (3) total medication copayments. Statistical analyses included chi-square, independent and paired t tests, and analysis of variance with post hoc comparisons.


RESULTS
Of 2, 114 enrollees eligible for comprehensive diabetes care (CDC) according to HEDIS guidelines, 255 participated in the MTM intervention group and 56 patients were MTM eligible but opted out of the program or could not be reached for medication review during 2008 (MTM nonparticipants). A higher proportion of patients in the MTM participant group had LDL-C levels less than 100 mg/dL (69.0%) compared with those in the MTM nonparticipant (50.0%) and CDC only (54.1%) groups (chi2 = 20.9(3), P < 0.001). The two control groups' average LDL-C (90.8 and 93.6 mg/dL) was significantly higher than the intervention group (83.4 mg/dL, P < 0.001). Overall, per member per month use and drug costs differed from 2007 to 2008 and enrollees in the MTM participant group had greater percentage cost reductions.


CONCLUSIONS
Enrollees who were eligible for MTM services but did not receive them had poorer clinical, use, and cost outcomes compared with the MTM intervention group. Pharmacists collaborating with physicians through a MTM program can improve quality of metrics for chronic diseases and reduce medication costs.
Fox
David
D
Florida Health Care Plans, Holly Hill, USA.
Ried
L Douglas
LD
Klein
Gary E
GE
Myers
Wendy
W
Foli
Kristen
K
D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000592:standards; D054524:Medicare Part D / Q000191:economics; D054539:Medication Therapy Management / Q000191:economics* / Q000592:standards; D019984:Quality Indicators, Health Care; D014481:United States
D008078:Cholesterol, LDL