Polypharmacy is a familiar topic for many when discussing adherence and prescribing behavior. With the increasing prevalence of this issue among medically complex seniors—as many as 4 in 10 seniors now take 5 or more prescriptions, a 300% increase since 2000[1]—it is no surprise CMS is including three polypharmacy-related display measures for the 2022 quality measure performance year.
To learn more about the display measures and their significance to health plans and plan members, we turned to Tori Erxleben Rush, PharmD and Product Director at RxAnte, who manages clinical programs, user training, and RxAnte’s Client Portal. She is responsible for ensuring all products are up to date with the latest industry information and providing a clinician’s input to all products.
What are the polypharmacy measures being considered and what are they measuring?
For the 2022 quality ratings performance year, CMS has the following three display measures: Polypharmacy Use of Multiple Central Nervous System (CNS)-Active Medications in Older Adults; Polypharmacy Use of Multiple Anticholinergic (ACH) Medications in Older Adults; and Concurrent Use of Opioids and Benzodiazepines. Display measures are tracked by CMS and can include new measures that may be considered as future Star Ratings measures.
These specific polypharmacy measures seek to minimize use of the targeted medications—specifically by looking to keep overlap of medications under a thirty day period and avoid members ‘qualifying’ for any of these measures. A member that qualifies for any of these polypharmacy measures would have thirty or more days of overlap in the targeted medications, which is meant to be avoided due to their associated health risks.
Why are these display measures important?
The addition of these measures is meant to address concerns around patient safety. For instance, concurrent use of benzodiazepines and opioids is associated with increased risks of falls and confusion[2].
Also, many instances of polypharmacy involving these targeted medications are the result of patients going to multiple prescribers, with no communication between those prescribers and a lack of coordinated care. Drawing attention to this issue can present an opportunity for more prescriber communication from health plans and patient education to reduce the frequency of polypharmacy among these medications.
How are RxAnte and Mosaic addressing these measures?
At RxAnte, we’re updating patient files for interested clients to include alerts for patients that already qualifying for these measures or are near qualifying; for example, if a member has 15 days of overlap on benzodiazepines and opioids, we’ll flag that member for the health plan to either communicate with that prescriber, or perhaps engage in patient counseling to alert them to the risks associated with their concurrent use. We will be making polypharmacy data available for all clients on the RxAnte Client Portal and we are adding a polypharmacy “tile” for those clients who have RxEffect.
Mosaic has been flagging opportunities to address these polypharmacy measures using reports that leverage RxAnte’s proprietary Therapeutic Decision SupportTM technology to review member regimens for health risks and cost saving opportunities. Using these flagged opportunities, Mosaic pharmacists are able to inform discussions with members and their prescribers to optimize medication regimens and reduce the number of prescriptions where appropriate.
As these new display measures shed more light on the risks and challenges we face in managing unnecessary polypharmacy, RxAnte and Mosaic are providing new solutions to both address these measures and the avoidable health risks they pose to their Medicare members. Interested in reading more on our thoughts on addressing unnecessary polypharmacy? Read our last post on this topic here.
To learn how RxAnte and Mosaic can improve medication use within your member population, contact us today.
References
[1]Chartbook on Long-term Trends in Health
[2]Concurrent Use of Opioids with Other Central Nervous System-Active Medications Among Older Adults