High-risk medication intervention program reduces refills with prescriber outreach

Tuesday, September 20, 2016

Situation

The elderly are prescribed more medications than any other age group in the U.S. Unfortunately, many of the medications may lead to unnecessary complications, additional ailments, and drug toxicity. This frail population is at risk for catastrophic consequences due to multiple prescribers who may not be aware of their patient’s complete medication list – which can sometimes include more than a dozen prescriptions.

In the 1990s, there was significant movement to combat this issue with the introduction of Medication Therapy Management (MTM) and the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (Beers Criteria). Both initiatives provide a much-needed framework to improve therapeutic outcomes in the elderly population, but high-risk medication use remains a pervasive problem.

Challenges

  • Every year, one in six adults, age 65 or older, has one or more adverse reactions to a medication or medications.
  • Studies show that adverse drug events are preventable 27 percent to 42 percent of the time in primary care and long-term care settings, respectively.
  • Health care expenditures related to potentially inappropriate medication use in community-dwelling elderly patients has reached more than $7 billion.

Solution

The University of Massachusetts Medical School (UMass) created a Centers for Medicaid and Medicare (CMS) Star Rating-focused intervention program for one client that features targeted prescriber outreach to members who have filled certain high-risk medications. Our clinical pharmacy team conducted live phone calls with prescribers and their staff to discuss the prescribed high-risk medication(s) and suggest alternatives, when applicable. After the initial nine months of this program, we reviewed and compared claims for the original prescription and refills of these high-risk medications.

Since 1999, UMass has provided customized, results-oriented prescription drug management services for states and health care organizations nationwide. We carefully design client-centric programs, including MTM and Star Rating enhancement services, that ensure members are only prescribed drugs that are medically necessary, medically appropriate, cost-effective, and in compliance with federal and state regulations.

Results

  • We conducted 10,751 calls for the identified high-risk medication prescription claims.
  • Our team completed 8,635 calls for our Medicare Part D client. A completed call was defined as live communication to a prescriber or an employee at their office, in which a recommendation was suggested for a member taking a high-risk medication.
  • On average, we had an 80 percent completed call rate.
  • Because of our efforts, 45 percent of high-risk medication prescription claims filled during this period were not refilled. This indicates discontinuation or change to a safer medication.