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High risk medication prescriptions and the impact on a plan’s Star Rating

By Signify Health News on 9/20/16 12:01 PM


The American Geriatrics Society (AGS) added benzodiazepines, commonly prescribed to treat insomnia and sleeplessness, as potentially inappropriate medication (PIM) according to the Beers Criteria in 2015. Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents; in general, all benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults.

However benzodiazepines remain the most commonly prescribed agents for sleep problems such as insomnia. With studies that link these types of drugs to increased falls, fractures, hospitalization, delirium and cognitive impairment, the Centers for Medicare & Medicaid Services (CMS) recently adopted this category of drugs into two Star Ratings measures to align with the AGS updated Beers Criteria:

  • Use of High-Risk Medications in the Elderly
  • Potentially Harmful Drug-Disease Interactions

Additionally, NCQA adjusted the reporting rate to assess two or more dispensing events for the same high-risk medication in “Use of High-Risk Medications in the Elderly.” Now that CMS has charged health plans with reducing incidents where seniors are repeatedly prescribed these medications, what are some ways you can reduce high risk medication usage?

One method is to educate members. Many don’t understand the risk and just want the benefits and relieve these medications provide. However, senior falls are costly and dangerous. And educating members on the correlation between these types of drugs and falling may help them reconsider this course of treatment and seek alternative therapies.

This issue can be addressed during a health risk evaluation, resulting in beneficial outcomes for both the member and your Star Ratings. After reviewing a member’s adherence and dosage of medications, the physician conducting the assessment can determine if there is an increased risk that needs to be discussed. This can help close the Part C Star Measure, Care for “Older Adults – Medication Review” and can also influence both “Reducing the Risk of Falling” and the Part D Measure “High Risk Medication.”  People who take four or more prescription drugs have a greater risk of falling than do people who take fewer drugs, making the medication review a critical component of the in home assessment.

Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies
Alternatives for Medications Listed in the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults