Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure.

Hung A, Wilson L, Smith VA, Pavon JM, Sloan CE, Hastings SN, Farley J, Maciejewski ML. Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure. JAMA health forum. 2024 May 3; 5(5):e240807.

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Abstract:

IMPORTANCE: Comprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourage the use of CMRs. OBJECTIVE: To examine trends in CMR completion rates before and after 2016 and whether racial, ethnic, and socioeconomic disparities in CMR completion changed. DESIGN, SETTING, AND PARTICIPANTS: This observational study using interrupted time-series analysis examined 2013 to 2020 annual cohorts of community-dwelling Medicare beneficiaries aged 66 years and older eligible for a CMR as determined by Part D plans and by objective minimum eligibility criteria. Data analysis was conducted from September 2022 to February 2024. EXPOSURE: Adoption of CMR completion as a Star Rating quality measure in 2016. MAIN OUTCOME AND MEASURES: CMR completion modeled via generalized estimating equations. RESULTS: The study included a total of 561?950 eligible beneficiaries, with 253?561 in the 2013 to 2015 cohort (median [IQR] age, 75.8 [70.7-82.1] years; 90?778 male [35.8%]; 6795 Asian [2.7%]; 24?425 Black [9.6%]; 7674 Hispanic [3.0%]; 208?621 White [82.3%]) and 308?389 in the 2016 to 2020 cohort (median [IQR] age, 75.1 [70.4-80.9] years; 126?730 male [41.1%]; 8922 Asian [2.9%]; 27?915 Black [9.1%]; 7635 Hispanic [2.5%]; 252?781 White [82.0%]). The unadjusted CMR completion rate increased from 10.2% (7379 of 72?225 individuals) in 2013 to 15.6% (14?185 of 90?847 individuals) in 2015 and increased further to 35.8% (18?376 of 51?386 individuals) in 2020, in part because the population deemed by Part D plans to be MTM-eligible decreased by nearly half after 2015 (90?487 individuals in 2015 to 51?386 individuals in 2020). Among a simulated cohort based on Medicare minimum eligibility thresholds, the unadjusted CMR completion rate increased but to a lesser extent, from 4.4% in 2013 to 12.6% in 2020. Compared with White beneficiaries, Asian and Hispanic beneficiaries experienced greater increases in likelihood of CMR completion after 2016 but remained less likely to complete a CMR. Dual-Medicaid enrollees also experienced greater increases in likelihood of CMR completion as compared with those without either designation, but still remained less likely to complete CMR. CONCLUSION AND RELEVANCE: This study found that adoption of CMR completion as a Star Rating quality measure was associated with higher CMR completion rates. The increase in CMR completion rates was achieved partly because Part D plans used stricter eligibility criteria to define eligible patients. Reductions in disparities for eligible Asian, Hispanic, and dual-Medicaid enrollees were seen, but not eliminated. These findings suggest that quality measures can inform plan behavior and could be used to help address disparities.