Medication Therapy Management in TennCare Medicaid Shows Promise in Pilot Study

Results of pilot effort to implement medication therapy management (MTM) in Tennessee’s Medicaid program did not reduce costs or spur widespread improvements in medication use, according to results presented at the Academy of Managed Care Pharmacy's annual meeting.

However, there were some positive impacts, as there were fewer emergency department (ED) visits, and adherence to some therapies for certain chronic diseases increased.

MTM is an established part of Medicare and can also be used in other populations as well, noted researchers from the University of Tennessee Health Science Center, which conducted the study with TennCare, the state’s managed care program. The prospective study ran from July 2018 to December 2020 in order to analyze the impacts on resource utilization, costs, and medication adherence.

The MTM program was funded by CMS, said Justin Gatwood, PhD, MPH, associate professor at University of Tennessee Health Science Center, who presented the findings. Adding MTM services is part of the state’s overall plan to transform primary care, which so far has also included mental health care coordination, an expansion of the patient-centered medical home model, and a care coordination tool to alert providers about patients who need transplant care services.

Members were selected based on their risk-score calculation, which was provided to the 3 managed care organizations participating in the state's Medicaid program. The organizations delegated counseling responsibilities and provided reimbursement to trained and credentialed pharmacists in TennCare. The MTM services were provided using a multipayer, online care coordination tool.

Each week the pharmacists would get weekly updates about patients who were eligible for services, Gatwood said. Initial visits were in-person visits, and care summaries would be sent back to the provider.

Gatwood said 2 separate time periods were used because after the program was implemented, they made certain refinements to enhance services, such as by improving data integration and reimbursement. The first period ended at the end of 2019, and the second continued through 2020.

The analysis examined pre/post changes in health care costs and resource utilization, as well as select Healthcare Effectiveness Data and Information Set measures and medication adherence for high-prevalence conditions, such as diabetes, asthma, depression, and hypertension.

Comparisons were made between TennCare members with and without MTM visits over 2 separate program periods using propensity score matching techniques followed by t tests, Wilcoxon signed-rank tests, and χ² tests.

During the study, 1352 members received MTM services; these Medicare embers tended to be Black (45.6%), female (60.1%), and working-age adults, although later on, more pediatric patients were included.

A decrease in both mean and counts of ED visits was found in both observation periods. Results also showed improvements in the asthma medication ratio, increasing from 0.31 to 0.48 (P < .05).

During 2020, the proportion adherent to their oral diabetes medication as measured by proportion of days covered (> 80%) increased from 29.7% to 36.3% (P < .001).

The program has not yet shown cost savings or led to consistent improvements in medication use across the board, although Gatwood said, "we have to really take the results from March of 2020 onward with a grain of salt because of the impact the pandemic certainly had."

In the future, he said, they would probably recommend "more of a targeted approach. There was a lot of heterogeneity within the patient population, which made assessment somewhat challenging." Focusing on certain disease states or population subgroups might yield the greatest results, he said.

Reference

Williams-Clark R, Underwood L, Ndrianasy E, Hohmeier K, Chiu CY, Gatwood J. Impact of the Tenncare medication therapy management pilot program. Presented at: Academy of Managed Care Pharmacy; March 29-April 1, 2022; Chicago, IL. Abstract Z1.