Case Study: Improving Outcomes for Medically Complex and Vulnerable Medicare Members

Medicare members who are “medically complex” – treating multiple chronic conditions with several maintenance medications – experience unique pharmacy challenges. They may have difficulty with activities such as organizing and remembering to take medications, traveling to the pharmacy, or affording the prescribed regimen. They are also at greater risk of polypharmacy-related adverse drug events.

A regional health plan client has partnered with Mosaic Pharmacy Service to offer a comprehensive pharmacy intervention to this population with the goal of improving medication use, clinical quality, and downstream medical costs.

Mosaic is a comprehensive, home-based pharmacy service that makes taking multiple daily medications safer, simpler, and more affordable for complex Medicare members. The evolution of this intervention is being performed by RxAnte using administrative claims data.

“Mosaic is transforming the pharmacy experience at a critical time for vulnerable seniors while helping us achieve our business objectives. We look forward to expanding the service and broadening its impact.” – Chief Pharmacy Officer of Health Plan

Design

The collaboration between the health plan and Mosaic began in December 2019. Performance is being evaluated using a non-randomized, propensity-matched controlled design. Enrollees were matched to non-enrolled members with similar demographics, medical and pharmacy cost burden, and medication regimen characteristics.

Eligibility was based upon drug therapy burden, risk of medication non-adherence, and members in need of medication therapy management. A total of 349 members were enrolled during the first four months, using live telephonic outreach from the health plan client’s pharmacy contact center. The measurement period included a 180-day look-back period prior to enrollment and a 90-day post-enrollment window. Measurement of longer term outcomes is ongoing.

The following outcomes were measured:

• Adherence: Improvement in triple-weighted CMS Star Ratings measure for oral diabetes medications, RAS antagonists, and statins
• Prescribing: Polypharmacy / high-risk medication quality measure performance
• Potential cost savings
• Member satisfaction

Intervention

Eligible members expressing interest in the Mosaic service were offered enrollment. Once enrolled, Mosaic interviewed each member about their medication beliefs, medical history, and current medication regimen. Therapeutic Decision Support™ software was tailored to the member’s drug plan and used to assist Mosaic’s clinical pharmacists in the identification of cost savings and safety enhancements to the member’s regimen.

Mosaic provided the following services to enrolled members:

• Reconciliation of medications on hand with those on health plan claims history
• Clinical reviews of medication regimen supported by proprietary analysis of health plan claims data
• Coordination with prescribers to optimize regimen based on identified safety, effectiveness, and cost savings opportunities
• Monthly medication delivery in adherence packaging
• Ongoing medication counseling
• 24×7 pharmacist availability

Results

90 days after initial medication reconciliation and first medication fill, Mosaic members demonstrated the following outcomes: