Managed Care

Plans not mining data that could prevent falls

Health plans are not fully using data that could improve the management of pharmacy for older patients, according to a study conducted by the PBM Prescription Solutions and published in the American Journal of Managed Care.

The results could help MCOs prioritize specific medications and patients to target for interventions designed to reduce the use of PIMs (potentially inappropriate medications) in this population. Patients who received sedative hypnotics (a PIM classified as Beers high-severity, or BHS) were significantly more likely to suffer a fall or fracture than those who did not. Also, patients receiving these drugs had significantly higher adjusted medical and total health care costs than those who were not receiving them.

Brad Curtis, MD, medical director at the PBM, says, “Plans can save money by decreasing prescriptions, but they’ll save additional money by not having these members fall and break their hip [as a result of taking the medication]. The adjusted cost estimate shows what the reduced rate of adverse events translates into as far as cost savings to the system.”

Patients who took PIMs visited the ER more often

Patients who took PIMs had greater adjusted costs

Source: Stockl KM, Le L, Zhang S, et al. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care. 2010;16(1):e1–e10.

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