Junling Wang, PhD, has done extensive research into the efficacy and inequity of Medicare Part D and MTM specifically. A lack of information about how MTM impacts racial minorities makes achieving any meaningful progress very difficult, and her work largely centers around better understanding how MTM and Medicare impacts people of color differently than non-Hispanic white patients.

To do this, she is working on a project called “Equity and Economic Effects of MTM Services,” the goals of which are:

“Aim 1: Test the hypothesis that MTM programs have reduced racial/ethnic disparities in quality of medication utilization, and health services utilization and costs. Aim 2: Test the hypothesis that non-Hispanic Blacks and Hispanics receive fewer and delayed MTM services than Whites. Aim 3: Test the hypothesis that MTM is a cost-effective program.”

(University of Tennessee, https://mtmstarvalue.uthsc.edu/equity-and-economic-effects-of-mtm-services/).

Thus far, Dr. Wang’s publications take the first steps in achieving these goals.

Her work on MTM eligibility finds that this criteria often carries the possibility of excluding many patients who could benefit from the service, for example.

In 2015, Dr. Wang and colleagues noted that many MTM programs set their requirements for eligibility close to the maximum permitted by CMS (251). She also published a paper on MTM criteria under the Affordable Care Act, noting that under the eligibility requirements, Hispanic patients would be significantly less likely to qualify for MTM than their white counterparts (Wang et al., 2015, p. 9). This limits access to a valuable service for many patients.

A 2010 retrospective analysis found that Black and Hispanic patients would be less likely than white patients to qualify for MTM services under 2006 and 2010 Medicare criteria. The authors note that Black and Hispanic patients are generally less likely to use health or pharmaceutical services, which may be required to qualify for MTM (Wang et al., 2010, p. 1076). While this article is fairly old, it sets a historical precedent for inequity within eligibility criteria that could negatively impact patients.

Furthermore, a 2014 article noted that the implementation of Part D criteria did not significantly reduce the racial and ethnic disparities that were already present in MTM eligibility criteria (Wang et al., 2014, p. 355). This highlights the need for more intentional steps towards progress in MTM eligibility criteria.

These inequities are despite the fact that populations who are treated worse by the medical system in general are often those that would benefit most from MTM services. In a study of Medicare CMR recipients researchers found that compared to white patients, Black patients were more likely to be nonadherent to diabetes, hypertension, and hyperlipidemia medications, while Hispanic patients were more likely to be nonadherent to hyperlipidemia medication (Dong et al., 2021, p. 7). Given MTM’s role in increasing medication adherence, ensuring that patients of color are given access to these services is crucially important. White patients were also more likely to self-report good health status than Black or Hispanic patients, and this disparity was even greater for patients not receiving MTM services (Wang et al., 2014, p. 115).

Thanks to the research of Dr. Wang and her colleagues, though, the usefulness of MTM services to mitigate racial and ethnic disparities is not merely theoretical. In a study of statin adherence in Medicare patients with Alzheimer’s Disease, researchers found that CMRs were associated with reduced disparities in nonadherence. The nonadherence rate for Black patients was 4.53% higher than that of white patients for CMR recipients compared to 7.53% for non-recipients, while the nonadherence rate for Hispanic recipients was 2.69% higher than white patients for CMR recipients, compared to 7.38% higher for non-recipients (Browning et al., 2022, p. 4).

Another 2021 study found that receiving a CMR was associated with a reduction in disparities in hypertension medication nonadherence in relation to white patients of 8% for Black patients, 18% for Hispanic patients, 16% for Asian patients, and 9% for other racial and ethnic groups (Dong et al., 2021, p. 105).

Furthermore, a 2023 study found that the cost-effectiveness of MTM-services was higher among Black patients than White patients (Tsang et al., p. 654).

Dr. Wang’s research is extremely important because of its capacity to inform how to best serve older adults and people of color, who often have worse health outcomes or are not treated as well in the health system, and highlight the role that MTM can play in achieving a more equitable system. She has not only researched existing inequalities in the provision of MTM services, but produced data displaying MTM’s potential in improving existing racial and ethnic health care disparities, data that can hopefully be employed to prove the importance of increasing access to these services.

Bibliography

Browning, J. A., Tsang, C. C. S., Zeng, R., Dong, X., Garuccio, J., Wan, J. Y., Chisholm-Burns, M. A., Finch, C. K., Tsao, J. W., & Wang, J. (2022). Racial/ethnic disparities in the enrollment of Medication Therapy Management programs among Medicare beneficiaries with Alzheimer's disease and related dementias. Current medical research and opinion, 38(10), 1715–1725. https://doi.org/10.1080/03007995.2022.2103962

Browning, J. A., Tsang, C. C. S., Dong, X., Wan, J. Y., Chisholm-Burns, M. A., Finch, C. K., Tsao, J. W., Liu, C., & Wang, J. (2022). Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer's Disease: an observational analysis. BMC health services research, 22(1), 159. https://doi.org/10.1186/s12913-022-07483-8

Dong, X., Tsang, C. C. S., Wan, J. Y., Shih, Y.-C. T., Chisholm-Burns, M. A., Dagogo-Jack, S., Cushman, W. C., Hines, L. E., & Wang, J. (2021). Exploring racial and ethnic disparities in medication adherence among Medicare comprehensive medication review recipients. Exploratory Research in Clinical and Social Pharmacy, 3, 100041. https://doi.org/10.1016/j.rcsop.2021.100041