Health care resource utilization in Medicare beneficiaries obtaining medication synchronization

Abstract

Background

An appointment-based medication synchronization (ABMS) is a service whuch aligns patients’ chronic medications to a predetermined routine pickup date and includes a comprehensive medication review or other clinical appointment at the pharmacy.

Objective(s)

We compared healthcare utilization outcomes (outpatient, inpatient, emergency department visits, and pharmacy utilization) of Medicare beneficiaries enrolled in a med-sync program to beneficiaries not enrolled in such a program.

Methods

This retrospective cohort study included Medicare beneficiaries obtaining medications from pharmacies providing ABMS. All Medicare inpatient, outpatient, emergency, and pharmacy claims data from 2014 to 2016 obtained from the Research Data Assistance Center. These pharmacy claims were used to create med-sync (n = 13,193) and non–med-sync cohorts (n = 156,987). All patients were followed longitudinally for 12 months before and after a 2015 index or enrollment date. Baseline characteristics were used to create a logistic regression model for propensity score matching. A 1:1 greedy nearest neighbor matching algorithm was adapted for sequentially matching both cohorts. Difference in differences (DID) was used to compare mean changes in health care utilization outcomes (outpatient, inpatient, ED visits, and pharmacy utilization) between cohorts.

Results

After matching, 13,193 beneficiaries in each cohort were used for analysis. DIDs for mean of health care utilizations were statistically significantly lower in the med-sync cohort than the non–med-sync cohort for outpatient visits (DID 0.012, P = 0.0073) and pharmacy utilization (DID 0.013, P < 0.0001). There was not a statistically significant DID for inpatient and ED visits between cohorts.

Conclusion

Outpatient and pharmacy utilization changes were statistically significantly lower in the med-sync cohort than the non–med-sync cohort in the 12 months after enrollment. Lower pharmacy utilization could be caused by reducing duplicate prescriptions during synchronized refills or optimization of therapy during medication reviews if patients are enrolled in appointment-based model med-sync.