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ADVERSE DRUG EVENTS (ADEs): Using Medicare Claims to Identify High-Risk Populations
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
6© 2019, Telligen, Inc.
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]
