Muskie School of Public Service
Institute for Health Policy
Evaluating the Impact of Part D on
Beneficiaries: Early Lessons
Susan Payne
Institute for Health Policy
Muskie School of Public Service
Muskie School of Public Service
Institute for Health Policy
Objectives
• To describe the early impact of an outreach
and education effort to encourage Part D
enrollment
• To draw lessons for evaluating the impact
of Part D on beneficiaries
2006 Academy Health Annual Research Meeting
Seattle, Washington
Muskie School of Public Service
Institute for Health Policy
Experience of MaineCare Workers with
Disabilities -- Dual Eligibles -- before
and during the Transition from
Medicaid to Medicare Part D
Authors: Carolyn Gray and Larry Glantz
Consultants: Kim Fox and Susan Payne
Funded by CMS
Muskie School of Public Service
Institute for Health Policy
The Workers with Disabilities option
(aka WWD Option, Working Disabled,
or Medicaid Buy In)
• Enables workers with disabilities to earn up to 250%
Federal Poverty Level and still keep MaineCare (Maine
Medicaid) benefits
• Eligibility
• Meet Social Security guidelines for a disability
• Have a job
• Meet financial guidelines
• More info at www.maine.gov/dhhs/beas/work
Muskie School of Public Service
Institute for Health Policy
Special outreach was in addition to assistance from
MaineCare to all dual eligibles
• Buy In participants are dual eligibles –
Medicare and MaineCare.
• Nationally, 36% of Medicare
beneficiaries are dual eligibles.
• They tend to have fewer financial
resources, more health problems, and
higher health care costs than other
Medicare beneficiaries.
• Informational phone calls: Provided basic information
about the transition to raise awareness and provide
resource information
• Brochures and mailings: Information on what the
change means for duals, how to decide what plan is
best, potential problems getting medications, and how
to resolve issues
• Informational sessions and video: Targeted sessions
for service providers and for duals about transition to
Part D
• Webpage: Disability-specific information and resources
linked to the state’s Medicare Part D website
1
Muskie School of Public Service
Institute for Health Policy
Institute for Health Policy
Muskie School of Public Service
Survey to assess special outreach efforts
to Buy-In Members
Caveats
•Supported by CMS
•Phone interviews conducted in March, 2006, 66 questions.
Knowledge about Part D, evaluation of outreach and
education efforts, experience so far in using it
•Self reported information -- not validated
•Emergency coverage (“wrap”) was in effect -measures impact on enrollment
•$5 prepaid phone card offered as an incentive
•Average time of 15 minutes
•60% response rate: 299/501
Muskie School of Public Service
Institute for Health Policy
Results
Institute for Health Policy
Muskie School of Public Service
•Letters and news/newspapers most common
source of information
• There was a high level of reported enrollment
– 87%.
• There was still some lack of knowledge…..
•In person assistance the most helpful.....
Learned about Medicare Part D and What Was Most Helpful in Answering Questions
100%
81%
70%
Knowledge about changing plans (n=289)
24%
26%
9%
50%
28%
12%
10%
10%
6%
0%
2%
1% 0%
1%
ho
tlin
e
se
ss
io
n
Ph
on
e
at
io
na
l
In
fo
rm
Ad
s
W
eb
sit
e
ca
lls
ta
nc
e
In
fo
rm
at
io
na
l
O
th
er
as
sis
pe
rs
on
Br
oc
hu
re
r
29%
In
Know how to
change plans
29%
15%
0%
36%
Le
tte
rs
se
nt
Ne
ws
/n
ew
sp
ap
e
Aware can change
plans monthly
50%
49%
50%
Q1 How did you learn about Medicare Part D? (n=299)
Know where to get
assistance to
change plans
Muskie School of Public Service
Of those who answered "yes" to Q1 in this category, the percent who said it was most helpful in answering questions
48%
Institute for Health Policy
Muskie School of Public Service
Institute for Health Policy
Conclusions
•85% had tried to buy medications under Part D. Of
those.....
•19% had problems getting a prescription filled
•15% had to switch to a different medication
•4% had to switch to a different pharmacy
•8% said the change in coverage affected their
health
• There will be a continuing need for
personalized outreach and education to
beneficiaries.
• It is feasible to get information from
beneficiaries on Part D by phone.
•There was some confusion and lack of information
about enrollment.
2
Muskie School of Public Service
Institute for Health Policy
Evaluation of the MaineCare Preferred
Drug List : Preliminary results
Authors: Susan Payne, Robert Keith,
Deborah Thayer, and Erika Ziller
Funded by: Maine Department of Health
and Human Services and Edmund S.
Muskie School of Public Service
Muskie School of Public Service
Institute for Health Policy
Muskie School of Public Service
Institute for Health Policy
Objective
To evaluate the impact of the MaineCare (Maine
Medicaid) Preferred Drug List (PDL) on
Continuity of medication use
Potentially drug-related adverse event rates
Muskie School of Public Service
Institute for Health Policy
Data and methods
Preliminary results: Continuity
Design: Retrospective observational study
Population: MaineCare members eligible for full benefits for
>5 months during the study period who were enrolled prior
to April 1, 2003
Data: MaineCare and Medicare administrative data. Due to
data limits, this report covers MaineCare only group (n= c.
200,000)
Study period: January, 2003, through June, 2004 (18
months pre PDL, 18 months post PDL)
Medications: 67 higher-volume medications, with
medications consistently classified and used as either
preferred or non-preferred during the study period
Analysis: Descriptive statistics, graphs, and Poisson
regression analysis
Members discontinued medications frequently before the PDL was
introduced.
Muskie School of Public Service
Institute for Health Policy
Adverse events -- deaths, drug-related falls,
adverse drug reactions, emergency visits, hospital
and nursing home admissions
There were no apparent trends in adverse event
rates when all members were studied. Trends did
show up when smaller groups were studied.
There were different patterns by medication:
Changes in medication discontinuity from pre-PDL to full PDL implementation period
(n=67)
Number and percent of
Therapeutic subclasses
with…
Preferred
medications
Non-preferred
medications
Increase in discontinuity
38.9%
91.0%
No change
9.0%
3.0%
Decrease in discontinuity
52.2%
6.0%
Total
100.0%
100.0%
Muskie School of Public Service
Institute for Health Policy
Looking at the subgroup of members who
discontinued a drug after it was put on the
PDL…..
Rates for some adverse events got
Better (dropped) after the PDL was implemented:
emergency visits
Stayed the same: deaths, falls, adverse drug reactions,
nursing facility admissions
Got worse (increased): hospital admissions
3
Muskie School of Public Service
Institute for Health Policy
Muskie School of Public Service
Institute for Health Policy
Conclusions
• Include a broad range of therapeutic classes
of medications.
• Compare use and switching patterns before
and after Part D.
• Document changes in formularies over time
OR study only medications that were
consistently classified.
• Study subgroups.
• Include a variety of outcomes.
• Account for related measures.
• Medicaid was a great source of information on
members’ medication use prior to Part D. This
emphasizes the importance of current,
comprehensive data on medication use after Part
D.
4