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

Abstract

Adverse drug events (ADEs) represent an expensive societal burden that disproportionally affects older adults. Therefore, value-based organizations that provide care to older adults—such 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.

Keywords: Medicaid; Medicare; Program of All-Inclusive Care for the Elderly; adverse drug events; drug-related problems; medication safety; medication-related problems; pharmacists.

Figure 1

MRM workflow. Abbreviations: CDSS = clinical decision support software; MRM = medication risk mitigation, MRP = medication-related problem; PACE = The Program of All-Inclusive Care for the Elderly.

Figure 2

Breakdown in year-over-year cost reduction seen in MRM relative to control. ¹ Cost reduction represents the difference between the intervention and control group’s 2018-to-2019 change in medical costs. Adjustments were applied to the control group’s 2018 and 2019 costs. Adjustments were based on the actual capitated rate. This ensured that geographic differences between MRM and control did not bias outcomes. ² Denotes a statistically significant (p < 0.05) difference between MRM and control groups.