Reducing Racial/Ethnic Disparities in Alzheimer’s-Type Dementia with MTM Services

Compared to non-Hispanic Whites (Whites), racial/ethnic minorities suffer from higher prevalence of Alzheimer’s disease (AD) and some associated vascular conditions, exhibit lower medication adherence, and incur higher healthcare costs. A critical barrier for resolving racial/ethnic disparities among AD patients is the lack of effective strategies to improve medication utilization among this population. Our Parent R01 examines the effects of medication therapy management (MTM) programs in the Medicare prescription drug benefit (Part D) on racial/ethnic disparities, but our original plan did not include AD-specific analysis mainly because of small sample size. With newly granted access to data for 100% Medicare beneficiaries, we now propose to examine the effects of MTM on medication utilization and health services utilization/costs among AD patients. The Centers for Medicare & Medicaid Services (CMS) established MTM in 2006 to improve pharmacotherapy outcomes, but because of program design issues, CMS decided to modify MTM and launched a demonstration of the Enhanced MTM Model in 2017. While the existing MTM has been shown to lead to higher medication adherence among patients with vascular conditions, based on an interim report from 10/2019, Enhanced MTM failed to exert a positive impact on utilization of medications or health services. Our study will thus provide timely information when CMS ponders MTM policy options after completing the Enhanced MTM demonstration in 2022. Our long-term goal is to improve the health status of older adults among diverse populations by reducing racial/ethnic disparities in medication utilization and health outcomes. We will analyze 100% Medicare Parts A/B/D data (2016-2017) linked to Area Health Resources Files. For medication utilization, we will measure initiation/discontinuation/persistence of antidementia medication and will apply utilization measures of medications, including those for vascular conditions, in Part D Star Ratings, a federal health-plan-quality evaluation system. Our expected outcomes include new information on: (1) effects of MTM on study outcomes among AD patients; (2) effects of MTM on racial/ethnic disparities in study outcomes among AD patients; and (3) measures of MTM utilization that exhibit disparity patterns among AD patients. Aim 1: Test the hypothesis that MTM services have improved quality of medication utilization and reduced health services utilization/costs among AD patients. Aim 2: Test the hypothesis that MTM has reduced racial/ethnic disparities in medication utilization and health services utilization/costs among AD patients. Aim 3: Test the hypothesis that racial/ethnic minorities received fewer/delayed MTM services than Whites among AD patients. Impact: Our results will provide empirical evidence to guide CMS policy-making for MTM, improve AD management, and assist the NIA/NIH in its strategic goals of “develop(ing) strategies to improve the health status of older adults in diverse populations.” Because the existing MTM has been shown to improve medication utilization among individuals with vascular conditions, this study is highly likely to produce meaningful results.