Situation: Seniors are on too many medications, it’s expensive and it’s getting worse
The healthcare industry broadly recognizes unnecessary polypharmacy as a costly challenge that impacts patients, providers, and health plans in negative ways. Nearly 50% of Medicare-aged adults take one or more medications that are not medically necessary, and this rate is increasing as more adults reach senior-age. This problem has far-reaching implications in terms of both health outcomes and healthcare spending. Evidence suggests the risk of prescribing error, high‐risk prescribing, and adverse drug events increases as the number of prescribed drugs rises. Research also shows that avoidable readmissions associated with polypharmacy account for more than $20B in annual healthcare spending. How can we fix it?
One way is “deprescribing.” The term “deprescribing” was first coined in 2003 and generally describes a path to addressing this issue. While published definitions of deprescribing vary, we use this definition: “the systematic process of identifying and discontinuing drugs in instances where existing or potential harms outweigh benefits within the context of an individual patient’s care goals, current level of functioning, life expectancy, values, and preferences.” Deprescribing is part of the good prescribing continuum, which spans therapy initiation, dose titration, changing or adding drugs, and switching or ceasing drug therapies.
Why Haven’t We Solved Polypharmacy Yet?
If we’ve known about unnecessary polypharmacy for a long time, and we’ve known deprescribing is a great way to address it, why hasn’t this situation been solved already? The answer is one we’re all too familiar with as an industry – healthcare is complex. Specifically, getting the pieces to align in a way that makes the most of deprescribing isn’t something anyone has mastered yet. That’s happening for a few primary reasons:
- Differing clinical guidelines across conditions. This translates into three to four medications per polychronic patient, often adding up to six to nine (or more) daily medications.
- Disparate prescribers – each with only part of the puzzle. Prescribers are often unable to obtain a holistic view of a patient’s medication regimen, typically stemming from one or both of these underlying problems:
- Patients are unable or unwilling to articulate what medications they’re truly taking (versus what has been prescribed) and associated barriers (e.g., side effects, cost, or social determinants of health factors).
- EMRs often don’t connect across prescribers or facilities, resulting in partial views of a patient’s medication data. This is significantly worse for patients with chronic conditions, who often see multiple clinicians.
- Even where holistic views exist, the means to adjust prescriptions don’t. Health plans may have access to the holistic picture of a patient’s medications via administrative claims data; however, they can’t make recommendations to their members—this is left to the care provider.
The New Role of Health Tech – Including RxAnte
The trick is to connect health technology in such a way that it empowers plans to take advantage of those benefits. Right now, we collect clinical guidelines by indication and use those to develop algorithms to identify deprescribing opportunities at the member level. One of the tools we use for that is administrative claims data – as one example, we can look back in time to see what members are diagnosed with when they receive something and when they are likely to have gone beyond a point where they shouldn’t be taking a drug anymore. That’s a large number, and it has enabled us to develop that library over time.
Yet, we recognize that it is only a piece of the polypharmacy issue. Deprescribing and polypharmacy go hand-in-hand, but we are at a place now to be more strategic and measurable in how we approach polypharmacy. We need to be flagging those particular cases where 1) a member is on a particular drug and likely overusing it and 2) a member shouldn’t be using a certain drug to begin with. Over time, the algorithms are becoming better refined to make this strategy a more meaningful way of tackling polypharmacy issues.
The Health Industry – Addressing Polypharmacy Together
Polypharmacy is a symptom of a bigger issue. To fix it, the health industry needs to act and think as a bigger, more united front, holding itself accountable for cost, patient outcomes and education, and regimen complexity. All stakeholders need to buckle down, using deprescribing in more powerful ways to effect real change at an industry level.
As the Medicare population grows and becomes more complicated, we’re seeing sharp rises in complex care, relating to complex medical needs. As more of those elderly members want to age at home, we’re going to see areas for improvements to the lives of this underserved population. Deprescribing as an intervention, and specifically as a treatment for polypharmacy, is a “win” for everyone – members included.
We already help regional and national MAPD plans with this. We can help you, too.