Contributor: How Medication Risk Scores Improve Health for Medicare Beneficiaries

What are medication risk scores, and how do they help improve patient health?

Medication risk scores indicate the risk of medication-related harm. The risk score highlighted in a 3-part series in The American Journal of Managed Care® (AJMC®) takes a unique approach that utilizes an individual’s medication regimen in analyzing the potential for simultaneous, multi-drug interactions, which can cause adverse drug events (ADEs) and other medication-related harm. More specifically, this risk score uses characteristics of active medication ingredients to analyze several risk factors, such as anticholinergic cognitive burden and sedative burden. Such simultaneous, multi-drug analysis more precisely indicates a patient’s risk of medication-related harm when compared to the traditional one-to-one drug analysis. 

Broader use of simultaneous, multi-drug analysis can help prevent avoidable ADEs. Each year, ADEs cause over 1 million emergency department visits, according to the CDC, and they remain a critical issue in the United States.

Why is it important in the Medicare population to use medication risk scores?

Polypharmacy, or the use of multiple drugs to treat health conditions, is more prevalent among older adults, many of whom have more than 1 chronic condition. This can leave older adults more vulnerable to ADEs.

Using medication risk scores from a population, such as Medicare participants who receive services through the Program of All-Inclusive Care for the Elderly, can help identify who are most vulnerable. Based on an individual’s medication risk score, pharmacists can make recommendations to prescribers to reduce the potential for simultaneous, multi-drug interactions and, therefore, medication-related harm.

What is the relationship between medication risk scores and outcomes like emergency department visits or inpatient hospitalizations?

The relationship between the medication risk score that analyzes the potential for simultaneous, multi-drug interactions and outcomes is explored in the 3-part AJMC® series. The first study demonstrates a direct association between a high medication risk score and potential negative health care outcomes, including medical costs, adverse drug events, falls, emergency department visits, hospitalizations, hospital length of stay, and mortality.

For example, expected emergency department visits grew 7% per 1-unit increase in the medication risk score per year. In addition, a 3% increase in hospital admissions was predicted per 1-unit increase in the risk score. Plus, each unit increase in the risk score was associated with an 8.5% increase in total medical expenditure (Medicare Part A and Part B).

The second study used the medication risk score to target participants for their first-ever medication safety review. For the study, pharmacists identified medication-related problems, including improper drug selection, dose too high, and dose too low, among others. Pharmacists then made recommendations (eg, to start alternative therapy, change dose). According to the results, the recommendations could markedly reduce the average risk score.

In the final study in the series, the medication risk score was used to target participants, who formed 2 groups. Participants in one group received a medication safety review in 2018 and at least one review in 2019. Participants in the second group did not receive reviews. The group with the reviews demonstrated more favorable year-over-year changes related to total medical costs (8.5% vs. 16.0%), hospital admissions (-3.4% vs. 6.6%), and emergency department visits (2.3% vs. 12.6%).

What is the benefit for payers and providers when they use this data?

The risk score discussed in the research series represents a new model for targeting individuals, by identifying risk factors related to their medication regimen which can be modified by recommendations made through medication safety reviews.

These reviews represent a win-win. They improve health outcomes for participants or patients and help reduce medical costs. For example, according to the third study in the AJMC® series, the group with the medication safety reviews had more favorable year-over-year changes related to Medicare Part A expenditures (7.2% vs. 15.2%) and Medicare Part B expenditures (13.0% vs. 18.8%).

The ability to reduce medical costs is paramount, as health care spending is a major concern in the United States. According to National Health Expenditure (NHE) data from CMS, total national health expenditures rose from $74.1 billion in 1970 to over $4 trillion in 2020.

Reducing avoidable medication-related harm can have a significant impact on health care spending. In addition to emergency department visits, ADEs can lead to hospitalizations, follow-up doctor visits, and additional medical care. In preventing ADEs, unnecessary health care costs can be avoided.