Abstract
Adherence to renin angiotensin system antagonists (RASA), non-insulin diabetes medications (NIDM) and statins has been included in the Medicare Star Ratings program since 2012. The long-term use of these measures emphasizes adherence to a limited number of chronic medications and may present opportunities for Part D plan sponsors to misuse the measures to influence their Medicare Part D Star Rating. It also does not capture the adherence needs of high-risk patients with multiple chronic conditions. The objective of this study was to describe the development of a new measure to capture adherence to multiple medications for chronic conditions (MMCC). The MMCC measure captures adherence to 71 different therapeutic categories of medication and was constructed using North Carolina Medicaid prescription claims data from 2015 to 2017. This measure was validated against the existing RASA, NIDM and statin adherence measures. This new measure was highly correlated with Star Rating measures, captured a greater number of eligible patients than these existing measures and had a lower proportion of patients meet the adherence threshold than the existing Star Ratings adherence measures. There is an opportunity to develop new measures, which include adherence to multiple medications in populations with multiple chronic conditions.
Highlights
The objective of this study is to describe the development of a measure of medication adherence for patients using multiple medications for chronic conditions
We examined the potential criterion validity of the newly developed multiple medications for chronic conditions (MMCC) measure by correlating the measure with the three existing Star Ratings measures, which have gone through prior validation
In 2017, the percent of patients eligible for adherence measures for non-insulin diabetes medications (NIDM), renin angiotensin system antagonists (RASA) and Statin medications that were adherent to treatment as defined by a proportion of days covered (PDC) ≥ 80% (51.3%, 44.0% and 51.2%) was higher than the percent of patients adherent to the MMCC measure (34.6%)
Summary
It is estimated that 50% of older adults have three or more concurrent chronic medical conditions [1]. It is estimated that 66% of total U.S health care spending is directly attributable to a disproportionally small number of approximately 27% of American’s with MCC [2]. This burden is felt by the health care system, and by patients through higher morbidity and mortality as well as reductions in patient reported quality of life [3] This burden is felt by the health care system, and by patients through higher morbidity and mortality as well as reductions in patient reported quality of life [3] (p. 15)
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