title: Impact of a Medicare MTM program: evaluating clinical and economic outcomes.
abstract: OBJECTIVE
  To assess the impact of a Medicare Medication Therapy Management (MTM) program in a large integrated health plan on patient mortality, hospitalization and emergency department (ED) utilization, and daily prescription costs.
  
  
  METHODS
  Retrospective matched cohort study.
  
  
  METHODS
  Patients who received MTM services between 2006 and 2010 were matched to control patients who were enrolled in Medicare but did not receive MTM services. They were matched in a 1:4 ratio based on age, gender, geographic location, and prospective diagnostic-cost-group (DxCG) risk score. Multivariate regressions were used to analyze the outcomes. Subgroup analyses were conducted for patients enrolled in 2010 because the Centers for Medicare & Medicaid Services lowered the drug-cost threshold for MTM eligibility and changed from opt-in to optout participation.
  
  
  RESULTS
  We identified 34,532 members who received MTM services and 138,128 control members. The MTM group was found to have a significantly reduced mortality (hazard ratio 0.86, 95% confidence interval [CI], 0.84-0.88; P <.001), lower odds for hospitalization (odds ratio [OR] = 0.97, 95% CI, 0.94-0.99; P = .018), higher odds for emergency department visits (OR = 1.17, 95% CI, 1.14-1.20; P <.001), and no differences in change in daily medication costs when compared to the matched group. The subgroup analysis of the 2010 cohort found similar results with better outcomes than the overall cohort.
  
  
  CONCLUSIONS
  Medicare MTM services resulted in lower mortality and odds for hospitalization for enrolled patients compared with matched controls. This study observed an increase in ED visits and no differences in change in daily medication costs in MTM services.
authors.affiliation: 1800 Harrison St, Ste 1301, Oakland, CA 94612. E-mail: Rita.L.Hui@kp.org.
authors.forename: Rita L
authors.initials: RL
authors.lastname: Hui
authors.forename: Brian D
authors.initials: BD
authors.lastname: Yamada
authors.forename: Michele M
authors.initials: MM
authors.lastname: Spence
authors.forename: Erwin W
authors.initials: EW
authors.lastname: Jeong
authors.forename: James
authors.initials: J
authors.lastname: Chan
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000458:organization & administration*; D054524:Medicare Part D / Q000191:economics / Q000458:organization & administration; D054539:Medication Therapy Management / Q000191:economics / Q000458:organization & administration*; D009026:Mortality; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D012189:Retrospective Studies; D014481:United States