Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; UPMC Centers for High-Value Health Care and Value-Based Pharmacy Initiatives, UPMC Insurance Services Division, Pittsburgh, PA, USA.
Express Scripts Holding Company, St. Louis, MO, USA.
Value Health. 2019 Nov;22(11):1266-1274. doi: 10.1016/j.jval.2019.06.009. Epub 2019 Aug 16.
In 2012, Medicare incorporated medication adherence targeting oral antidiabetic medications, renin-angiotensin system (RAS) antagonists, and statins as highly weighted components in its Star Ratings Program. In the same year, health plans began receiving quality bonus payments for higher star ratings.
We aimed to assess how these policy changes affected adherence to targeted and other chronic disease medications in the United States.
We performed interrupted time series analyses to assess monthly changes in medication adherence from 2010 to 2016 using health plans' Medicare claims submitted to a large pharmacy benefits manager. We conducted 2 sets of analyses. The first examined whether policy changes affected adherence to the 3 targeted therapy classes, and the second assessed the association between policy changes and adherence to 5 chronic disease classes not targeted by star ratings. For the second analysis, we further compared adherence between members who concomitantly used and did not use targeted medications.
For star-ratings analyses, we studied 240 811 members on oral antidiabetic medications, 500 958 on RAS antagonists, and 471 135 on statins. Adherence for all star rating-targeted and nontargeted medications increased after 2012 (P < .001). Oral antidiabetic, statin, and RAS antagonist adherence was, respectively, 11.2%, 3.7%, and 8.1% higher than adherence without policy changes (P < .001). Nontargeted antihypertensive and antihyperlipidemic adherence trends were higher among those concomitantly on star rating-targeted medications compared with those who were not (P < .001).
As policy makers strive to identify optimal quality measures for improving healthcare delivery, it is important to consider that incentives can promote improved performance in both targeted measures and related outcomes.
2012 年，医疗保险将药物依从性靶向口服降糖药物、肾素-血管紧张素系统（RAS）拮抗剂和他汀类药物作为其星级评定计划中的高度加权组成部分。同年，健康计划开始因更高的星级评定而获得质量奖金。
我们旨在评估这些政策变化如何影响美国靶向和其他慢性疾病药物的依从性。
我们使用大型药房福利管理公司提交的医疗保险索赔进行了中断时间序列分析，以评估 2010 年至 2016 年期间药物依从性的每月变化。我们进行了两组分析。第一组分析了政策变化是否影响了 3 种靶向治疗类药物的依从性，第二组评估了政策变化与 5 种未被星级评定靶向的慢性疾病类药物的依从性之间的关联。对于第二项分析，我们进一步比较了同时使用和未使用靶向药物的患者之间的依从性。
对于星级评定分析，我们研究了 240811 名口服降糖药物患者、500958 名 RAS 拮抗剂患者和 471135 名他汀类药物患者。自 2012 年以来，所有星级评定靶向和非靶向药物的依从性都有所增加（P <.001）。与没有政策变化相比，口服降糖药、他汀类药物和 RAS 拮抗剂的依从性分别提高了 11.2%、3.7%和 8.1%（P <.001）。同时使用星级评定靶向药物的患者的非靶向降压药和降脂药的依从性趋势高于未使用的患者（P <.001）。
随着政策制定者努力为改善医疗保健提供找到最佳质量措施，重要的是要考虑到激励措施可以提高靶向措施和相关结果的绩效。
