Medication Management Case Study

Background Super-utilizers place a substantial burden on the U.S. healthcare system and have become the focus of policy initiatives aimed at reducing their disproportionate inpatient and emergency department (ED) visits. Medication management is a critical component for these patients since nonadherence to medications is associated with poor health outcomes, and higher health care utilization and costs.

Objectives The primary aim was to examine the association between sociodemographic, clinical, medication-related, health services utilization factors and medication nonadherence, with particular emphasis on factors including mental illness, chronic pain, and use of opioid medications in super-utilizers with MCC and polypharmacy.

Design, Setting, and Participants: This study is based on the SafeMed Program, a care transitions program targeting super-utilizers with MCC and polypharmacy. We conducted a panel analysis of the 2-year baseline data for Medicare Part D beneficiaries meeting SafeMed Program eligibility criteria from February 2013 to December 2014. The unit of analysis was patient-period. The 2-year data for each patient was divided into four six-month patient-periods.

Main Outcomes and Measures The primary outcome included repeated measures of
The majority of the population was dual-eligible (63.5%), received low-income cost sharing subsidy (70.3%), had >2 chronic conditions (94.7%), had chronic pain (77.1%), and used >1 opioid medication (68.7%), in the fourth period. In the multivariate model, factors associated with medication nonadherence included age 1 opioid medication filled (OR: 1.32, CI: 1.14-1.53), outpatient physician visits (OR: 1.03, CI: 1.01-1.07), and period 4 (OR: 1.24, CI: 1.05-1.47). Physician office visits were associated with decreased nonadherence (OR: 0.98, CI: