title: Improving Comprehensive Medication Review Acceptance by Using a Standardized Recruitment Script: A Randomized Control Trial.
abstract: BACKGROUND
  The Centers for Medicare & Medicaid Services (CMS) require prescription drug plan sponsors to offer a comprehensive medication review (CMR) annually to eligible beneficiaries through the plans' Medication Therapy Management Programs (MTMPs). In 2011, the Pharmacy Quality Alliance endorsed the CMR completion rate as a quality measure for MTMPs, and CMS has adopted the measure into the 2016 CMS star ratings. CMS star ratings are used to describe the quality of plans to assist Medicare plan enrollees in choosing a plan and to determine quality bonus payments for Medicare Advantage plans. Star ratings are measured on a scale of 1 to 5, with 5 being the highest possible rating for an individual measure. Currently, the majority of plans score 2 stars or less on the CMR completion rate measure.
  
  
  OBJECTIVE
  To demonstrate the effectiveness of a standardized CMR recruitment script emphasizing the benefits of the service to increase acceptance of CMR offers among beneficiaries of a Medicare prescription drug plan.
  
  
  METHODS
  A CMR recruitment script, shaped by the Health Belief Model, was developed based on a previous pilot study. The original script described the CMR service but did not emphasize key benefits or barriers from the beneficiary perspective. The updated script aimed to enhance beneficiary understanding of the CMR service, explain the benefits from the beneficiary perspective, and address potential barriers to accepting the service. The updated script was tested during the 2012 MTMP enrollment in a randomized controlled experiment, using the original script as the control. The CMR service was offered to MTMP members via phone calls by live call agents who spoke with members who answered, using 1 of the 2 scripts. Both scripts asked members if they were willing to have a pharmacist call them back and perform a CMR at a later date. Two call attempts were made to all eligible beneficiaries. If contact was not made after 2 unsuccessful outreach attempts, a computer-generated voicemail message was left, and an informational letter regarding the MTMP and CMR was subsequently mailed. CMR acceptance rates, defined as the proportion of beneficiaries who spoke with a call agent and agreed to participate in the CMR service, divided by the total number of beneficiaries contacted who confirmed their membership with the Part D plan, were compared between those exposed to the original script and those exposed to the updated script. Multivariate logistic regression was employed to examine factors that may have influenced members' decisions regarding the offer to participate in CMRs.
  
  
  RESULTS
  There were 105,701 beneficiaries in the first quarter of the MTMP 2012 enrollment who were eligible for the MTM service. Approximately 10% of eligible beneficiaries answered the live calls and listened to the scripts. On average, members who responded to calls were aged 68.9 years, prescribed 10.5 chronic medications, and had 6 different chronic conditions. Among members who answered the calls, 52.9% were exposed to the original script, and 47.1% heard the updated script. For the updated script, 48.2% of the members accepted the offer to be subsequently contacted by a pharmacist to complete the CMR, whereas 38.1% of members exposed to the original script agreed to the CMR offer. Logistic regression results indicated that members who received the updated script were 1.58 (95% CI = 1.45-1.72) times more likely to accept the CMR offer compared with those who received the original script. Among other factors, increased number of chronic medications (OR = 1.038, 95% CI = 1.020-1.057), increased number of disease conditions (OR = 1.039, 95% CI = 1.014-1.064), and previous involvement in the MTMP were positively associated with acceptance of the CMR offer.
  
  
  CONCLUSIONS
  The updated script outperformed the original script in promoting member willingess to participate in a CMR by describing key components and emphasizing benefits of participation. CMR engagement remains a challenge for Medicare plan sponsors. This study demonstrates that to overcome common hurdles to CMR engagement, sponsors should seek strategies to educate members regarding MTM programs and the benefits and components of a CMR.
  
  
  BACKGROUND
  No outside funding supported this study. Research for this study was conducted while Liu was a postdoctoral fellow at the University of Florida. Liu is currently an employee of the U.S. Food and Drug Administration (FDA). The views expressed here are those of the authors and not necessarily those of the FDA. Yang reports receiving a research fellowship funded by WellCare Health Plans at the time of this study. The authors report no other potential conflicts of interest. Study concept and design were primarily contributed by Yang, Segal, and Miguel, along with Hall, Liu, and Ballew. Miguel, Liu, Yang, Ballew, and Hall collected the data, which were analysed and interpreted primarily by Liu, along with Yang and Segal and assisted by the other authors. The manuscript was written primarily by Miguel, Hall, and Garret, along with Liu, Yang, and Ballew, and revised by Ballew, Segal, Hall, and Miguel, along with Liu and Yang.
authors.affiliation: 1 University of Florida MTM Communication and Care Center, Orlando.
authors.forename: Alexander
authors.initials: A
authors.lastname: Miguel
authors.affiliation: 1 University of Florida MTM Communication and Care Center, Orlando.
authors.forename: Anna
authors.initials: A
authors.lastname: Hall
authors.affiliation: 2 University of Florida College of Pharmacy, Gainesville.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: 1 University of Florida MTM Communication and Care Center, Orlando.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Garrett
authors.affiliation: 3 WellCare Health Plans, Tampa, Florida.
authors.forename: Angel
authors.initials: A
authors.lastname: Ballew
authors.affiliation: 2 University of Florida College of Pharmacy, Gainesville.
authors.forename: Tsu-Hsaun
authors.initials: TH
authors.lastname: Yang
authors.affiliation: 2 University of Florida College of Pharmacy, Gainesville.
authors.forename: Richard
authors.initials: R
authors.lastname: Segal
mesh_terms: D000368:Aged; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020398:Medicare Part C / Q000191:economics*; D054524:Medicare Part D / Q000191:economics*; D054539:Medication Therapy Management / Q000191:economics*; D010593:Pharmaceutical Services / Q000191:economics; D010594:Pharmacies / Q000191:economics; D010595:Pharmacists / Q000191:economics; D010865:Pilot Projects; D055553:Prescription Drugs / Q000191:economics*; D014481:United States
chemical_list: D055553:Prescription Drugs