ADVERSE DRUG EVENTS (ADEs)Identify outpatient ICD ADE codes by priority drug class. Rate of severe...
Transcript of ADVERSE DRUG EVENTS (ADEs)Identify outpatient ICD ADE codes by priority drug class. Rate of severe...
ADVERSE DRUG EVENTS (ADEs): Using Medicare Claims to Identify High-Risk Populations
© 2019, Telligen, Inc.
WHAT IS AN ADE?Harms occurring during medical care
resulting from medication exposure
Premature Death
Exacerbations of Disease
Millions in AvoidableHealthcare Costs
Increased Hospitalizations
Risks From ADEs Include:
2
3© 2019, Telligen, Inc.
ADEs: The Impact on Medicare
Hospital Utilization
> 1/3 of U.S. prescriptions are taken by seniors
Average elderly patient > 5 prescriptions
Average nursing home resident = 7
Contribute $3.5B to U.S. healthcare costs
Hospitalization rate is 7x higher for seniors
Cause 1M emergency visits each year
Elderly Prescriptions
Sources: Institute of Medicine, Agency for Healthcare Research & Quality, National Institutes of Health
4© 2019, Telligen, Inc.
ADEs: What We Already Know
OpioidPainkillers
DiabetesAgents
Anticoagulants(Blood Thinners)
Prevention is PriorityTimely dissemination of ADE data can increase prevention & quality
improvement efforts
Prevention is LimitedPrevention efforts are lacking a
standard surveillance system for tracking ADEs among seniors
HHS’ National Action Plan for ADE Prevention (2014)Identifies three priority medications responsible for 60% of ER visits by seniors:
5© 2019, Telligen, Inc. 5
PUBLICATION & TITLE:
DESIGN & CONCEPT:
VALUE TO MEDICARE:
SIGNIFIGANCE:
Journal of Managed Care &
Specialty Pharmacy (3/2019)
Use of Medicare claims to identify a population at high-
risk for ADEs
Telligen:Rachel Digmann,
Sherry Peppercorn, LiJing Zhang, Kim Irby, Jane Brock
CMS:Anita Thomas
Qsource:Amanda Ryan
Identifies populations at high-
risk for ADEs.
Calculates rates of hospitalization
among the high-risk.
Data will be shared for targeted quality
interventions.
Addresses a significant limitation
in Medicare’s medication safety
efforts by establishing a
uniform method for tracking ADEs among seniors.
ADE ANALYSIS: About the Study
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OBJECTIVE: Analyzing Claims Data
a
b
OBJECTIVE:Use claims data to
identify populations at high-risk for ADEs & hospital utilization
BACKGROUND:Medicare claims providethe data necessary for
tracking medication use patterns &. outcomes (ie.,
outpatient ADEs)
b
a
7© 2019, Telligen, Inc.
METHODS: Identifying High-Risk
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
Identify patients taking 3+ Rx, with 1 belonging to a
priority class
List all priority class Rx (by national drug
code) & merge with 12 mos Part
D claims
Priority class = anticoagulants, opioids & diabetes Rx
Dataset limited to Medicare Part D (Rx
plan) members
Identify & list all ICD codes associated
with outpatient ADEs by priority
drug class
Merge Medicare IDs #’s for high-risk
members with Part A (hospital) to
identify hospital care event
Includes advisor panel review of ICD codes
Hospital care event = ER, observation, inpatient
Link high-risk members to Part A claims to determine all-cause hospital
utilization
All-cause hospitalization = sum of all hospital care events over 12 mo. period
8© 2019, Telligen, Inc. 8
RESULTS: Characteristics of High-Risk Population
Female
(56%)
Under Age 75
(60%)
White (75%)
Non-Dually
Eligible (66%)
Urban Dweller
(65%)
9© 2019, Telligen, Inc.
OBJECTIVE METHOD RESULT
Identify populations at high-risk for ADEs
Identify those taking at least three medications; one being
a high-priority medication
8,178,753 beneficiaries at high-risk (20.7% of the
population)
Calculate annual rate of severe outpatient ADEs (i.e., ADEs causing hospital visit)
Identify outpatient ICD ADE codes by priority drug class
Rate of severe outpatient ADEs was 46.28/1000 (4.6%)
Evaluate rates of hospital utilization
Use claims to link high-risk beneficiaries to hospital care events (ED visit, observation
stay, admissions)
Primary care setting was the ED, followed by admissions &
observation
RESULTS: What the Study Found
10© 2019, Telligen, Inc.
RESULTS: Discussion TopicsThis Analysis Helps Us Understand . . .
Size of Population Taking High-Risk Rx
Risks Associated With Multiple Rx Use
Link Between Rx Use Patterns & Outcomes
Rx Use Patterns Over Time
Total ADEs By Drug Class Anticoagulants Risk
Smallest proportion of high-risk population . . .
. . . Highest rates of hospital utilization & ADEs
For More Information, Contact:
Teresa Titus-HowardVice President, Federal Health Solutions
(O) 443.561.3366 (C) 816.225.1874(E) [email protected]