This article is more than 5 years old. Information may no longer be current.
Medicare savings program fails to improve medication use, adherence
Exposure to the Medicare Shared Savings Program was not associated with increased medication use or adherence among patients with CVD and diabetes, according to recent findings.
“Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) are eligible for shared-savings bonuses if spending for their patient population falls below a financial benchmark,” J. Michael McWilliams, MD, PhD, of the department of health care policy at Harvard Medical School, and colleagues wrote. “Improving medication use and adherence may be additionally attractive to ACOs as a strategy to achieve savings because the MSSP does not include Part D prescription drug spending in an ACO’s spending or benchmark. Thus, increasing patients’ use of prescription drugs to improve performance on quality measures or to lessen the need for nondrug services may support greater shared-savings bonuses than other quality improvement efforts or substitutions that require increases in certain nondrug services.”
McWilliams and colleagues used fee-for-service Medicare claims from 2009 to 2014 as a comparison for the for the cohorts of ACOs entering into the MSSP in 2012, 2013 and 2014. Depending on drug class, the person-years analyzed ranged from about 4.5 million to 10.8 million.
The researchers assessed drug use (at least one prescription filled) and adherence (proportion of days covered) for six drug classes: statins, ACE inhibitors, angiotensin II receptor blockers, beta-blockers, thiazide diuretics, calcium channel blockers and metformin.
Compared with non-ACO participants, there were no significant changes in medication use for participants in MSSP ACOs except for a slight differential increase in the use of thiazides for hypertension in the 2013 entry cohort (adjusted differential change, 0.5 percentage points; 95% CI, 0.1-0.8; P = .01).
There were no significant changes in proportion of days covered, except for beta-blockers in the 2012 ACO cohort (adjusted differential change, 0.3 percentage points; 95% CI, 0.1-0.5; P = .003) and for metformin in the 2012 and 2013 ACO cohorts (adjusted differential change, 0.5 percentage points; 95% CI, 0.1-0.9; P = .01 for both).
“Through its third year of operation, the MSSP has been associated with minimal increases in the use of or adherence to common antihypertensive, lipid-lowering and hypoglycemic medications that improve [CV] outcomes,” the researchers wrote. “We could not analyze the effects of the MSSP on [BP], cholesterol or glucose levels directly because performance on disease control measures is reported only for ACOs and only after the start of ACO contracts, but our findings suggest that reported improvements in disease control among ACOs may reflect ongoing trends due to factors other than ACO contract incentives.” – by Cassie Homer
Disclosures: McWilliams reports being a paid consultant to Abt Associates in an evaluation of the ACO Investment Model. Two other authors report ties to CVS Health.