{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:08:06Z","timestamp":1790255286626,"version":"4.1.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008309","name":"Johns Hopkins Bloomberg School of Public Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008309","id-type":"DOI","asserted-by":"publisher"}]},{"name":"DecisionRx, Inc.","award":["152555"],"award-info":[{"award-number":["152555"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Medication-related problems are a persistent source of avoidable spending among Medicare beneficiaries, presenting an important opportunity to improve the quality of care for seniors and reduce financial burden on the Medicare program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated a pharmacist-led medication therapy optimization (MTO) program implemented in a Medicare accountable care organization population using a regression-adjusted difference-in-differences design with propensity score matching. The analysis included 1003 treated members and 14 031 matched controls contributing 334 531 member-months of claims data (2022-2025). The MTO program combined pharmacogenomic testing, a nine-vector medication-risk algorithm, comprehensive pharmacist review, and structured recommendations to prescribers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MTO participation was associated with a statistically significant reduction in total medical costs (pooled average treatment effect on the treated: \u221219.4%, \u2212$246 per member per month [PMPM]; P &amp;lt; 0.001). The treatment effect was strongly duration-dependent, growing from \u22124.7% in the first three months to \u221231.9% (\u2212$462 PMPM; P &amp;lt; 0.001) beyond nine months of program benefit. All care settings showed significant reductions: inpatient admissions \u221243.1% (P &amp;lt; 0.001), emergency department visits \u221241.3% (P &amp;lt; 0.001), and outpatient visits \u221228.3% (P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Medication therapy optimization was associated with significant cost savings. Parallel trends validation and a pronounced dose-response relationship support a causal interpretation. Short-duration evaluations are likely to substantially underestimate the full economic value of an MTO program.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag223","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:40:43Z","timestamp":1787658043000},"source":"Crossref","is-referenced-by-count":0,"title":["Cost and utilization outcomes of pharmacist-led medication therapy optimization in a Medicare ACO population"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1594-1199","authenticated-orcid":false,"given":"Hazem F","family":"Elewa","sequence":"first","affiliation":[{"name":"DecisionRx, Inc. , Indianapolis, IN 46278 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-5306","authenticated-orcid":false,"given":"Joseph F","family":"Levy","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health Department of Health Policy and Management, , Baltimore, MD 21205 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4133-2514","authenticated-orcid":false,"given":"Chintan","family":"Pandya","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health Department of Health Policy and Management, , Baltimore, MD 21205 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1995-997X","authenticated-orcid":false,"given":"Steven E","family":"Goldberg","sequence":"additional","affiliation":[{"name":"DecisionRx, Inc. , Indianapolis, IN 46278 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4585-8783","authenticated-orcid":false,"given":"Travis A","family":"Morgan","sequence":"additional","affiliation":[{"name":"DecisionRx, Inc. , Indianapolis, IN 46278 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"issue":"20","key":"2026092408520283000_qxag223-B1","doi-asserted-by":"publisher","first-page":"7388","DOI":"10.3390\/jcm14207388","article-title":"Polypharmacy as a chronic condition: a diagnostic mindset for safer and smarter care","volume":"14","author":"Jerjes","year":"2025","journal-title":"J Clin Med"},{"issue":"5","key":"2026092408520283000_qxag223-B2","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1001\/jamainternmed.2015.0324","article-title":"Reducing inappropriate polypharmacy: the process of deprescribing","volume":"175","author":"Scott","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"17","key":"2026092408520283000_qxag223-B3","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.1001\/jama.2015.13766","article-title":"Trends in prescription drug use among adults in the United States from 1999-2012","volume":"314","author":"Kantor","year":"2015","journal-title":"JAMA"},{"issue":"9","key":"2026092408520283000_qxag223-B4","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1177\/1060028018765159","article-title":"Cost of prescription drug-related morbidity and mortality","volume":"52","author":"Watanabe","year":"2018","journal-title":"Ann Pharmacother"},{"issue":"3","key":"2026092408520283000_qxag223-B5","doi-asserted-by":"publisher","first-page":"185","DOI":"10.18553\/jmcp.2010.16.3.185","article-title":"Medication therapy management: 10 years of experience in a large integrated health care system","volume":"16","author":"Ramalho de Oliveira","year":"2010","journal-title":"J Manag Care Pharm"},{"issue":"1","key":"2026092408520283000_qxag223-B6","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1001\/jamainternmed.2014.5841","article-title":"Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis","volume":"175","author":"Viswanathan","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"11","key":"2026092408520283000_qxag223-B7","doi-asserted-by":"publisher","first-page":"1963","DOI":"10.1377\/hlthaff.2013.0542","article-title":"Pharmacists belong in accountable care organizations and integrated care teams","volume":"32","author":"Smith","year":"2013","journal-title":"Health Aff (Millwood)"},{"issue":"5","key":"2026092408520283000_qxag223-B8","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1038\/clpt.2011.34","article-title":"Pharmacogenetics: from bench to byte\u2014an update of guidelines","volume":"89","author":"Swen","year":"2011","journal-title":"Clin Pharmacol Ther"},{"issue":"1","key":"2026092408520283000_qxag223-B9","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1055\/a-1288-1061","article-title":"Review and consensus on pharmacogenomic testing in psychiatry","volume":"54","author":"Bousman","year":"2021","journal-title":"Pharmacopsychiatry"},{"issue":"4","key":"2026092408520283000_qxag223-B10","doi-asserted-by":"publisher","first-page":"357","DOI":"10.18553\/jmcp.2023.29.4.357","article-title":"Telehealth medication management and health care spending in a Medicare accountable care organization","volume":"29","author":"Urick","year":"2023","journal-title":"J Manag Care Spec Pharm"},{"issue":"3","key":"2026092408520283000_qxag223-B11","doi-asserted-by":"publisher","first-page":"421","DOI":"10.3390\/jpm12030421","article-title":"Real-world impact of a pharmacogenomics-enriched comprehensive medication management program","volume":"12","author":"Jarvis","year":"2022","journal-title":"J Pers Med"},{"issue":"12","key":"2026092408520283000_qxag223-B12","doi-asserted-by":"publisher","DOI":"10.1111\/cts.70418","article-title":"Multi-gene pharmacogenomic testing in a community-based setting is feasible and reduces total healthcare costs","volume":"18","author":"El Rouby","year":"2025","journal-title":"Clin Transl Sci"},{"issue":"5","key":"2026092408520283000_qxag223-B13","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41397-024-00350-1","article-title":"Clinical and economic outcomes of a pharmacogenomics-enriched comprehensive medication management program in a self-insured employee population","volume":"24","author":"Fragala","year":"2024","journal-title":"Pharmacogenomics J"},{"key":"2026092408520283000_qxag223-B14","author":"Clinical Pharmacogenetics Implementation Consortium (CPIC)"},{"issue":"5","key":"2026092408520283000_qxag223-B15","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1111\/1475-6773.13666","article-title":"Confounding and regression adjustment in difference-in-differences studies","volume":"56","author":"Zeldow","year":"2021","journal-title":"Health Serv Res"},{"issue":"2","key":"2026092408520283000_qxag223-B16","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.jeconom.2021.03.014","article-title":"Difference-in-differences with variation in treatment timing","volume":"225","author":"Goodman-Bacon","year":"2021","journal-title":"J Econom"},{"key":"2026092408520283000_qxag223-B17","doi-asserted-by":"publisher","author":"Wooldridge","DOI":"10.1007\/s00181-025-02807-z"},{"issue":"3","key":"2026092408520283000_qxag223-B18","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1162\/rest.90.3.414","article-title":"Bootstrap-based improvements for inference with clustered errors","volume":"90","author":"Cameron","year":"2008","journal-title":"Rev Econ Stat"},{"key":"2026092408520283000_qxag223-B19","author":"Morgan"},{"key":"2026092408520283000_qxag223-B20","volume-title":"The Johns Hopkins ACG System, Version 14.0.1 Release Notes","author":"Johns Hopkins Bloomberg School of Public Health","year":"2025"},{"issue":"25","key":"2026092408520283000_qxag223-B21","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"issue":"7","key":"2026092408520283000_qxag223-B22","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1377\/hlthaff.2012.0848","article-title":"Increasing Medicare Part D enrollment in medication therapy management could improve health and lower costs","volume":"32","author":"Stuart","year":"2013","journal-title":"Health Aff (Millwood)"},{"issue":"9","key":"2026092408520283000_qxag223-B23","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.18553\/jmcp.2021.27.9.1198","article-title":"Evaluation of financial outcomes under a value-based payment program for community pharmacies","volume":"27","author":"Doucette","year":"2021","journal-title":"J Manag Care Spec Pharm"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag223\/70792500\/qxag223.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/9\/qxag223\/70792500\/qxag223.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/9\/qxag223\/70792500\/qxag223.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:52:11Z","timestamp":1790254331000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag223\/8770903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":23,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag223","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,8,26]]},"article-number":"qxag223"}}