Chief Medical Officer, Tabula Rasa HealthCare
As a previous PACE medical director, I found my time with participants to be rewarding. I enjoyed getting to know them and guiding them in their healthcare journey. So, being able to reduce the risk of preventable adverse drug events brought me genuine joy. I still remember one new participant, Mr. E, a 72-year-old accompanied by his daughter on his first clinic visit. His daughter started the conversation by saying, “Dr. Patel, please help us. My father has been falling a lot lately. He is confused, I am stressed out, and I don’t know what to do.”
It turns out Mr. E was on 36 medications prescribed by five different doctors. Using MedWise® Science technology and with the guidance of a CareKinesis clinical pharmacist, over the course of six months I was able to get Mr. E down to only nine medications. With his new regimen in place, he had only one fall, and his mental status was back to baseline, according to his daughter. Indeed, Mr. E looked like a new man. When I met his daughter again, she had tears in her eyes as she said, “Dr. Patel, you gave my father a new life. Thank you.”
Validated PACE Outcomes
This is one of many stories of PACE participants who enjoyed improved health following Medication Risk Mitigation (MRM) services provided by CareKinesis PACE Pharmacy. However, a new peer-reviewed study demonstrates the actual value of these services to PACE participants and their programs.
Tabula Rasa HealthCare’s research and development team looked at 2,545 participants from 19 PACE centers and found that that PACE programs receiving medication risk mitigation (MRM) services as clients of CareKinesis consumed $5,024 less per participant in medical costs year-over-year than PACE plans not using CareKinesis. Think of it: $5,024 per participant across a program’s entire census. That’s major. How does CareKinesis do this? What is different about CareKinesis services that generates such outcomes for their clients?
Four Steps to Reducing ADEs and Costs
The CareKinesis team takes four steps to mitigate the risks – and potential associated medical costs – of ADEs for PACE participants.
Step One: Real-Time Risk Stratification
The CareKinesis team accesses a real-time risk stratification using the MedWise Risk ScoreTM to identify PACE participants who are in jeopardy of experiencing adverse drug events. Using proprietary technology to assess their entire medication regimen, participants are scored from 0 to 50, with a score of 20 or higher considered high risk.
Step Two: Review
Once an at-risk participant is identified, a highly-trained clinical pharmacist will use MedWise® Science clinical decision support tools to review the participant’s regimen and identify medication-related problems that may contribute to an ADE. CareKinesis pharmacists are PharmDs who are board-certified in geriatric pharmacy and certified in the use of MedWise® Science technology.
Step Three: Pharmacogenomic (PGx) Clinical Services
PGx testing identifies on average 2.5-3.0 drug-gene based interactions for an individual. In a study of 200 PACE participants, 73.6% of PACE participants were on at least one medication for which they did not have the genes to fully metabolize. Annual cost avoidance was calculated to be nearly $2,000 per participant and nearly 90% of recommendations were accepted. The CareKinesis clinical pharmacist interprets the participant’s results for the PACE provider and offers appropriate interventions to the prescriber. Nearly 90% of recommendations were accepted. CareKinesis clients can consult with their clinical pharmacist to determine which participants might benefit from PGx services.
Step Four: Intervention and Implementation
Interventions are either prospective, at the point of prescribing/new Rx, or retrospective, which address medication-related problems in participants’ pre-existing medication list to prevent avoidable medication problems. Typically, a pharmacist identifies about two medication-related problems per PACE participant, and PACE providers accept nearly all of the pharmacist’s recommendations.
The reduction in risk score is on average three units per consultation. The majority of medication-related problems involve multi-drug-drug interaction, adverse drug reactions, high doses of medication, and medications without an indication or reason for it. Medication-related problems are often resolved through the implementation of changing time of administration, deprescribing, alternative mediation therapy, or adjusting doses.
When we focus on providing PACE participants high-quality care, the resulting improvement in medical outcomes ultimately leads to reduced medical costs, as shown in the study. And when we extend these outcomes to an entire PACE census, the results are significant for both participants and the PACE program.