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- W3028163048 abstract "Current Medicare health plan performance measures do not consider variations of patient characteristics within health plans, potentially leading to incorrect performance evaluations. This study examined the relationship between patient characteristics and high-risk medication (HRM) use and the impact of risk adjustment on HRM use measures among Medicare Advantage Prescription Drug Plan (MA-PD) and stand-alone Prescription Drug Plan (PDP) beneficiaries. This retrospective cross-sectional study used a 5% national sample of 2013 Medicare claims. Two groups of beneficiaries aged ≥65 years, continuously enrolled in MA-PD or PDP, and with ≥2 prescriptions for the same HRM (defined by Pharmacy Quality Alliance) were identified. First, we calculated unadjusted performance scores as a proportion of HRM users in each health plan. Second, we identified HRM use risk factors using multivariable logistic regression models for MA-PD and PDP. Third, we developed risk-adjustment scores using generalized linear mixed models to adjust for identified risk factors in specific plans within MA-PDs and PDPs. Agreement between unadjusted and adjusted scores was evaluated using Cohen’s kappa to demonstrate the effect of risk adjustment. This study included 520,019 MA-PD and 881,264 PDP beneficiaries (mean age=74.7±7.3 versus 75.6±7.8 years; females=61% versus 64%; white=81.7% versus 85.5%) enrolled in 474 MA-PD and 60 PDP contracts. In adjusted analyses, HRM users in MA-PDs were more likely to be younger (OR=0.981, 95%CI=0.980-0.983); women (OR=1.545, 95%CI=1.514-1.576); eligible for low-income subsidy (OR=1.086, 95%CI=1.057-1.115); disabled (OR=1.380, 95%CI=1.342-1.420); seeing multiple prescribers (OR=1.076, 95%CI=1.072-1.081); using multiple pharmacies (OR=1.092, 95%CI=1.083-1.102); and higher average modified RxRisk-V index (OR=1.176, 95%CI=1.171-1.181) than non-HRM users. PDP results were similar. Unadjusted scores had low levels of agreement (Cohen’s kappa <0.7) with risk-adjusted scores. This study suggests risk adjustment influences health plan performance evaluation. Thus, risk adjustment of HRM performance is recommended to ensure health plans are not penalized due to their beneficiaries’ characteristics." @default.
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- W3028163048 date "2020-05-01" @default.
- W3028163048 modified "2023-10-14" @default.
- W3028163048 title "PNS111 HEALTH PLAN PERFORMANCE ON HIGH-RISK MEDICATION USE AMONG MEDICARE PART D BENEFICIARIES: IMPACT OF RISK ADJUSTMENT" @default.
- W3028163048 doi "https://doi.org/10.1016/j.jval.2020.04.1114" @default.
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