adverse drug events (ades)identify outpatient icd ade codes by priority drug class. rate of severe...

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


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


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


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%)


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


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]

adverse drug events (ades)identify outpatient icd ade codes by priority drug class. rate of severe...

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