reports

MEDS-AD Waiver (MTM) Program final report

Prepared for Florida Medicaid. Tallahassee, FL, USA: College of Medicine, Florida State University.

Florida State University, Tallahassee, FL, USA

This report summarizes the final findings of the pre-intervention period (prior to June 1, 2011) and the MEDs-AD Waiver (intervention) years (June 1, 2011 through May 31, 2014) for the quantitative and qualitative evaluation of the Florida Medicaid Medication Therapy Management (MTM) intervention implemented by the University of Florida (UF) College of Pharmacy (COP). This report includes findings based on combined or pooled data for the first three years of the current waiver for the MTM program interventions beginning in 2011 (Year 1 Cohort 1), 2012 (Year 2 Cohort 2), and 2013 (Year 3 Cohort 3). The goals of the MTM program are to improve the quality of care and prescribing practices based on best-practice guidelines, improve patient adherence to medication plans, reduce clinical risk, and lower prescribed drug costs and the rate of inappropriate spending for certain Medicaid prescription drugs for a high-risk population of Medicaid recipients eligible through Florida’s Section 1115 MEDs-AD Research and Demonstration Waiver (MEDs-AD Waiver).

Within the quantitative component, MTM program participants (MTM-P) are compared with MTM program non-participants (MTM-NP). The MTM-NP is also referred to as comparison group 1 (CG1). Medicaid recipients who were members of the MEDs-AD Waiver Medicaid eligible population number three (MEG31), but either declined the opportunity to participate or were never contacted about the opportunity were used to form a second comparison group (CG2). The evaluation uses the latest available data for inpatient, outpatient, long-term care (LTC), medical, and pharmacy claim types as reported to the Florida Medicaid Agency on standard claims forms: UB-04 (facility) and CMS-1500 (professional services) as of September 2014.

Claims and enrollment data used for this report are believed to represent nearly all Medicaid recipient utilization for the period January 1, 2010 to May 31, 2014. Claims files are merged with demographic information. Periods of enrollment under the MEDs-AD Waiver and periods of excluded enrollment were identified. Additional information on the data used for this report is provided in the Method Section. Descriptive and regression tables for the pooled analysis of Cohort 1, Cohort 2, and Cohort 3 for the pre-intervention study period (SP-PRI) and the intervention study period (SP-INT) are presented and contrasted with comparison groups defined later in the report. Findings for the UF COP MTM process measures are also presented for Cohort 1, Cohort 2, and Cohort 3 using data provided by the UF COP MTM program.

The intervention period for each of the 3 cohorts is 12 months and is preceded by a 12 month observation period before the intervention in order to contrast the pre-intervention utilization with utilization during the intervention year. Therefore, each cohort and comparison group was followed for up to two years as long as the recipients maintained eligibility under the MEDs-AD Waiver for the MEG3 population. The intervention group population for all three cohorts totaled 456 recipients and the MTM-NP /(CG1) population for all three cohorts totaled 1,540 recipients before attrition. Additional information on the construction of comparison groups and the relationship between cohorts is presented in the Methods section.