Evaluating the Impact of Medication Risk Mitigation Services in Medically Complex Older Adults.

Adverse drug events (ADEs) represent an expensive societal burden that disproportionally affects older adults. Therefore, value-based organizations that provide care to older adults­such as the Program of All-Inclusive Care for the Elderly (PACE)­should be highly motivated to identify actual or potential ADEs to mitigate risks and avoid downstream costs. We sought to determine whether PACE participants receiving medication risk mitigation (MRM) services exhibit improvements in total healthcare costs and other outcomes compared to participants not receiving structured MRM. Data from 2545 PACE participants from 19 centers were obtained for the years 2018 and 2019. We compared the year-over-year changes in outcomes between patients not receiving (control) or receiving structured MRM services. Data were adjusted based on participant multimorbidity and geographic location. Our analyses demonstrate that costs in the MRM cohort exhibited a significantly smaller year-to-year increase compared to the control (MRM: USD 4386/participant/year [95% CI, USD 3040−5732] vs. no MRM: USD 9410/participant/year [95% CI, USD 7737−11,084]). Therefore, receipt of structured MRM services reduced total healthcare costs (p < 0.001) by USD 5024 per participant from 2018 to 2019. The large majority (75.8%) of the reduction involved facility-related expenditures (e.g., hospital admission, emergency department visits, skilled nursing). In sum, our findings suggest that structured MRM services can curb growing year-over-year healthcare costs for PACE participants.

Medication-related problems identified by pharmacists in an enhanced medication therapy management model.

OBJECTIVES: To describe the types of clinically actionable medication-related problems (MRPs) identified and the types of resolving recommendations issued by pharmacists using an advanced clinical decision support system (CDSS) for Medicare Part D beneficiaries. STUDY DESIGN: Retrospective cross-sectional study. METHODS: We examined frequencies of MRPs and recommendations for beneficiaries who received a first-ever medication safety review (MSR) during plan years 2018-2019. MRPs were considered clinically actionable if implementation of a recommendation would alter the medication regimen. RESULTS: Pharmacists identified ≥ 1 clinically actionable MRP for 82.4% (18,703/22,696) beneficiaries receiving an MSR. Among these beneficiaries, 36,455 MRPs were identified (mean [SD] number of MRPs: 1.9 [1.0]). "Adverse drug reaction" (n = 14,788; 40.6%), "drug interaction" (n = 9716; 26.7%), and "medication use without indication" (n = 6496; 17.8%) represented 85.0% of all MRPs. "Start alternative therapy" was most frequently recommended to resolve "adverse drug reactions" (6724/14,788; 45.5%), followed by "change time of administration" to resolve "drug interactions" (5189/9716; 53.4%) and "discontinue medication" to resolve "drug use without indication" (5718/6496; 88.0%). Overall, "start alternative therapy" (n = 12,219) and "discontinue medication" (n = 12,059) made up 66.6% of all recommendations. CONCLUSIONS: In Medicare Part D beneficiaries, pharmacists using an advanced CDSS identified a substantial number of MRPs pertaining to medication safety and issued recommendations to decrease the risk of adverse drug events.

Health outcomes from an innovative enhanced medication therapy management model.

OBJECTIVE: To evaluate the impact of pharmacist-delivered medication safety reviews (MSRs) on total medical expenditures, hospitalizations, emergency department (ED) visits, and mortality in Medicare Part D beneficiaries, whose plan was a participant of the Enhanced Medication Therapy Management model. STUDY DESIGN: Retrospective, pre-post, cohort study. METHODS: We evaluated the aforementioned outcomes for beneficiaries who were targeted, according to their MedWise Risk Scores (MRS), for MSR services in both 2018 and 2019. The "MSR" cohort included those who received their first-ever MSR in 2018 and received another MSR in 2019. The "failed to engage" (FTE) cohort included beneficiaries who were targeted in both 2018 and 2019 but did not engage in an MSR at any point through the end of 2019. For both cohorts, we calculated the change from 2018 to 2019 for each outcome and then determined whether unadjusted year-over-year changes differed significantly between cohorts. Additionally, these difference-in-differences (DiD) analyses were adjusted for baseline MRS and multimorbidity. RESULTS: A total of 11,436 beneficiaries were targeted for MSRs in both 2018 and 2019. Beneficiaries were, on average, aged 76.6 ±â€…10.0 years. The MSR cohort (N = 4384) outperformed the FTE cohort (N = 7052) in total medical costs (DiD = $958/y [7.5% savings]; P = .042), hospitalizations (DiD = 3.9 admissions/100 beneficiaries/y [10% reduction]; P = .032), ED visits (DiD = 6.2 visits/100 beneficiaries/y [10% reduction]; P = .014), and mortality (2.1% fewer died in 2019; P < .001). Each outcome remained significant after adjusting for baseline MRS and multimorbidity. CONCLUSION: MSRs were effective at improving annual health care costs, hospitalizations, ED visits, and mortality in Medicare beneficiaries targeted according to MRS.

Association of the MedWise Risk Score with health care outcomes.

OBJECTIVES: Older patients are especially vulnerable to drug-related problems due to multiple prescription drugs, which increases their risk of drug-drug interactions and adverse drug events (ADEs). This study aimed to examine outcomes associated with the MedWise Risk Score (MRS) in a Medicare Part D population, including total medical expenditures, ADEs, falls, mortality, emergency department (ED) visits, hospital admissions, and length of stay (LOS). STUDY DESIGN: Retrospective observational study. METHODS: The association between MRS and patient health outcomes was derived using drug claims data from 213,561 beneficiaries and medication risk stratification using outcomes data in 2018 with 1 year of follow-up. Analyses were conducted with the Max MRS and the Mean MRS calculated over the year. Analyses utilizing the Max MRS performed better, and results using the Max MRS are presented. Statistical analyses were performed using linear regression, logistic regression, negative binomial regression, and zero-inflated Poisson (ZIP) models. RESULTS: Of 203,630 patients studied (mean ±â€…SD age, 76.0 ±â€…8.0 years), 4.9%, 9.8%, 24.5%, and 15.5% experienced at least 1 ADE, fall, ED visit, and hospital admission, respectively, in 2018. The MRS was associated with an 8.5% change in total medical expenditure per 1-unit increase. The adjusted odds ratio (OR) of ADE was 1.058 (95% CI, 1.055-1.06)/unit MRS. ADEs, falls, and death were more likely in elevated MRS categories (eg, OR of 4.45 for ADEs [95% CI, 4.10-4.83], 5.51 for falls [95% CI, 5.17-5.87], and 4.42 for death [95% CI, 3.82-5.12], respectively forSevere MRS group). Our model predicts 7000 ED visits for every 100,000 patients per unit increase of the MRS. The ZIP models estimated ORs of 1.03 and 1.01 for hospital admissions and increase in hospital LOS, respectively, per MRS unit. CONCLUSIONS: This study shows that MRS was associated with health outcomes and therefore could be used to identify patients at increased risk of negative outcomes based primarily on their medication regimens.

Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly.

Preventable adverse drug events (ADEs) represent a significant public health challenge for the older adult population, since they are associated with higher medical expenditures and more hospitalizations and emergency department (ED) visits. This study examines whether a novel medication risk prediction tool, the MedWise Risk Score™ (MRS), is associated with ADEs and other pertinent outcomes in participants of the Programs of All-Inclusive Care for the Elderly (PACE). Unlike other risk predictors, this tool produces actionable information that pharmacists can easily use to reduce ADE risk. This was a retrospective cross-sectional study that analyzed administrative medical claims data of 1965 PACE participants in 2018. To detect ADEs, we identified all claims that had ADE-related International Classification of Diseases and Health Related Problems, 10th revision (ICD-10) codes. Using logistic and linear regression models, we examined the association between the MRS and a variety of outcomes, including the number of PACE participants with an ADE, total medical expenditures, ED visits, hospitalizations, and hospital length of stay. We found significant associations for every outcome. Specifically, every point increase in the MRS corresponded to an 8.6% increase in the odds of having one or more ADEs per year (OR = 1.086, 95% CI: 1.060, 1.113), $1037 USD in additional annual medical spending (adjusted R2 of 0.739; p < 0.001), 3.2 additional ED visits per 100 participants per year (adjusted R2 of 0.568; p < 0.001), and 2.1 additional hospitalizations per 100 participants per year (adjusted R2 of 0.804; p < 0.001). Therefore, the MRS can risk stratify PACE participants and predict a host of important and relevant outcomes pertaining to medication-related morbidity.

I don't want the money, I just want your time: How moral identity overcomes the aversion to giving time to prosocial causes.

Four studies show that moral identity reduces people's aversion to giving time-particularly as the psychological costs of doing so increase. In Study 1, we demonstrate that even when the cost of time and money are held equivalent, a moral cue enhances the expected self-expressivity of giving time-especially when it is given to a moral cause. We found that a moral cue reduces time aversion even when giving time was perceived to be unpleasant (Study 2), or when the time to be given was otherwise seen to be scarce (Study 3). Study 4 builds on these studies by examining actual giving while accounting for the real costs of time. In this study, we found that the chronic salience of moral identity serves as a buffer to time aversion, specifically as giving time becomes increasingly costly. These findings are discussed in terms of the time-versus-money literature and the identity literature. We also discuss policy implications for prosocial cause initiatives. (PsycINFO Database Record