Adherence to medication isn’t the only area to focus on for seniors covered by Medicare. Optimizing access to treatments and medicines is also important.
For any health plan, keeping members healthy is a big part of making sure they receive optimal treatments. This particularly concerns the elderly, in whom the wrong medicine or the wrong dose, or the use of unnecessary medicines, can lead to dangerous consequences, such as an increased risk of falls and hospitalization.1
Compared to the general population, older adults have a higher incidence of medication overload, where medication use causes more harm than good.2 Additionally, they are hospitalized for adverse drug events at a higher rate than the general population is hospitalized for opioids.2.3 These trends make it critical to ensure that older adults take the safest and most effective medications and adhere to prescribed regimens.
However, plan administrators who focus too narrowly on adherence may miss factors that pose barriers to accessing medications and optimizing health in older adults. In many cases, the socioeconomic and behavioral aspects of drug optimization are as important as the clinical aspects.4 This is especially true for elderly patients and people from racial and ethnic minorities, both of whom have historically faced structural and economic barriers that compound health problems – a serious problem that has become more evident during the pandemic. of COVID-19.
A Commonwealth Fund survey found that older Latino and black adults were more than twice as likely to report economic hardship related to COVID-19 compared to white patients, and overall the proportion of older adults who said they had exhausted their savings or lost their jobs during the pandemic was 4 to 6 times higher in the United States than in many other developed countries.5
The pandemic has also exacerbated the challenge of ensuring access to care for chronic conditions. In the same survey, 37% of seniors with 2 or more conditions reported canceling or rescheduling an appointment with a provider due to COVID-19.5 Another study found that 36% of black seniors and 39% of Latino seniors experienced a pandemic-related medical care disruption, compared to 31% of white adults in the same age group.6 These statistics underscore the importance of identifying those for whom adequate disease management means ensuring access to transportation, home care and/or drug delivery services. Additionally, language and cultural barriers combined with the complexity of medications underscore the importance of taking a holistic approach.
For any health insurance plan, the stakes are higher than just improving its star rating. A plan must not only provide members with the resources they need to stay safe and healthy, whether in the form of “whole person” home health care, educational programs or members with housing services; it must also be able to identify the members likely to benefit from such measures. Effective use of technology can address the complex web of factors that affect a person’s health care. Sophisticated, configurable algorithms that encompass social determinants of health such as age, ethnicity, and socioeconomic status enable targeted health planning and advice for individuals based on their specific needs. Driven by advanced artificial intelligence technologies, these algorithms can ensure that members are not only taking the right medications at the right dose, but also receiving culturally appropriate and inclusive care.
The urgency of optimizing medications among Medicare Advantage enrollees is underscored by the rapidly growing elderly population, with the number of Americans ages 65 and older expected to reach 80 million by 2040, when the number of people aged 85 and over is expected to nearly quadruple from 2000 levels.seven To ensure equitable care for this growing population, CMS has released a Health Equity Framework, a blueprint for designing and implementing policies and programs to eliminate avoidable health disparities.8 The approach places particular emphasis on chronic and infectious diseases (e.g., diabetes, COVID-19), which disproportionately affect members of historically underserved communities. CMS shares system and community-level strategies, including robust data and infrastructure systems; engage effectively with individuals, families, and caregivers as partners in their health care; and integrating population health efforts into measurement and payment.
The solution lies in adopting technology-enabled systems approaches to effectively and sustainably address health inequities. This means going beyond measuring immediate quality results; indeed, the well-being of the nation depends on the possibility of sustainable improvements in health, as evidenced by accessible and value-based care that ensures the safety, health and prosperity of our elderly populations.
1. Thomas EJ, Brennan TA. Incidence and types of preventable adverse events in elderly patients: population-based medical record review. BMJ. 2000;320(7237):741-744. doi:10.1136/bmj.320.7237.741.
2. Garber J, Brownlee S. Drug overload: America’s other drug problem. The Lown Institute. Published April 2019. https://lowninstitute.org/wp-content/uploads/2019/08/medication-overload-lown-web.pdf
3. Health Care Cost and Utilization Project (HCUP) Quick Statistics. Agency for Research and Quality in Health. Published in 2018. https://datatools.ahrq.gov/hcup-fast-stats.
4. Wilder ME et al. The impact of social determinants of health on medication adherence: a systematic review and meta-analysis. J Gen Med Intern. 2021;36(5):1359-1370. doi: 10.1007/s11606-020-06447-0.
5. Williams RD, Shah A, Doty MM, Fields K, FitzGerald M. The impact of COVID-19 on older adults. The Commonwealth Fund. September 2021. https://www.commonwealthfund.org/publications/surveys/2021/sep/impact-covid-19-older-adults
6. Guerrero LR, Wallace SP. The impact of COVID-19 on diverse older adults and health equity in the United States. Public Health Front. Published online May 17, 2021;9:661592. doi:10.3389/fpubh.2021.661592
7. The American population is aging. Urban Institute. Published in 2022. https://www.urban.org/policy-centers/cross-center-initiatives/program-retirement-policy/projects/data-warehouse/what-future-holds/us-population-aging
8. CMS Framework for Health Equity. CMS. Published 2022. Updated April 22, 2022. https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/framework-for-health-equity