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.