Conjoint analysis of patient preferences on Medicare medication therapy management

To identify attributes of medication therapy management (MTM) valued by Medicare beneficiaries and to determine patient preferences and willingness to pay for MTM attributes.

Cross-sectional contingency valuation study.

Six senior centers in Memphis, TN, from September 2007 through August 2008.

355 Medicare beneficiaries.

A discrete choice experiment was used, in which each study participant was asked to choose from two different hypothetical MTM services defined by seven attributes (service setting, provider type, number of drug therapy problems, provider experience in overall practice, provider experience in geriatrics, time spent, and cost of MTM service) and associated levels.

Patient preferences for different attributes of MTM services and patients' estimated marginal willingness to pay for each attribute level.

Study participants viewed cost (relative importance 32.2%) as the most important attribute of MTM, followed by service setting (24.2%), provider experience in overall practice (19.5%), and provider experience in geriatrics (16.6%). Community pharmacies (β = 0.146, P = 0.007) were the most preferred environment for MTM services, followed by clinics, whereas telephone consultation was the least preferred environment (β = -0.349, P < 0.001). Study participants were willing to spend as much as $31.76 (95% CI 19.84-45.27) to trade telephone MTM for clinic-based MTM. They also were willing to pay $13.31 more (3.60-23.65) for MTM service at a community pharmacy compared with clinic-based MTM.

Health plans should consider developing community pharmacy-based MTM options, at least for Medicare beneficiaries without mobility limitations.