BCBSRI Program Aims to Lower Senior Adverse Drug Events by 20%

Adverse drug events in older Americans cost approximately $3.8 billion in 2018, but a new program from Blue Cross Blue Shield of Rhode Island (BCBSRI) is looking to reduce costs by 20 percent while improving outcomes for seniors.

On average, hospitals admit 750 seniors every day due to an adverse drug reaction, a study by Lown Institute recently determined. At this rate, the Institute estimates that adverse drug reactions will cost Americans $62 billion over the next ten years.

With so many factors at play in a prescriber’s decision-making process, payers have a hard time pinpointing whether a prescription is a potentially inappropriate medication (PIM).

“We do not have the clinical context from the prescriber to always know the risk and benefit of a medication selection. While we do employ pharmacists to reach out to patients to help them understand their meds and assure safety, we cannot reach everyone and we cannot always tell whether a medication is appropriate,” Matt Collins, MD, vice president of clinical integration at BCBSRI explained to HealthPayerIntelligence.com.

But the payer is looking overcome these problems through a new program called EQUIPPED, or Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department.

Spearheaded by Elizabeth Goldberg, MD, ScM, assistant professor of emergency medicine at Brown University, the program combines education, individual provider feedback, and clinical decision support to prevent adverse drug events in adults 65 years and older.

Originally developed at Emory University, Goldberg and BCBSRI are bringing the program to New England for the first time. BCBSRI has arranged a quality contract with the state’s next largest hospital system. The insurer is also funding Goldberg as she shares her expertise with the hospital systems.

“The program is really about reducing the potential for adverse drug events in elders as they're coming out of the emergency room,” said Collins. “That has obvious down-stream impacts on things like their own experience but also the cost of dealing with one of those adverse drug events, whether that’s another trip to the ER or another treatment or hospitalization.”

Using the American Geriatrics Society’s Beers Criteria for Potentially Inappropriate Medication Use in Older Adults as its guideline, the EQUIPPED program builds a set of safe prescriptions directly into the hospitals’ EHR systems. Prescribers receive advisories regarding what is safe and appropriate to prescribe to their elderly patients.

For example, when an elderly patient is discharged from the hospital, the physician will use the hospital’s EHR to prescribe a medication. EQUIPPED will offer the prescriber suggestions from its customized prescription set regarding what is safe for their patient, given the patient’s age and condition. The suggestions aim to prevent future adverse drug events and lead to considerable savings due to decreased hospitalizations.

The EQUIPPED program also includes an educational facet that sends physicians a monthly “report card” to assess their prescribing rate and interactions. Goldberg then meets with physicians personally to address their scores and compare the results with their peers’. For any physicians who may be experiencing alert fatigue from an overwhelming number of system messages or who override the prescribing notifications, this guidance could be pivotal in helping them improve their prescribing processes.

Compared to other methods of reducing adverse drug events, EQUIPPED “might be more effective because it provides immediate direction at the point of prescribing to avoid potentially dangerous medications from being prescribed,” Collins explained

BCBSRI aims for a 20 percent reduction in potentially inappropriate medications through the EQUIPPED program. 

The payer is confident the program will help reduce PIMS. A similar program implemented by Emory University at 11 military Veterans Affairs Medical Centers and three civilian hospitals saw a significant decrease in PIM prescriptions at nearly all of the locations.

BCBSRI hopes to follow in the footsteps of these hospitals by reducing the number of adverse drug events experienced by their members. But the payer also intends for the program to help all patients at LifeSpan hospitals.

“EQUIPPED doesn’t explicitly impact explicitly Blue Cross members,” Collins added. “It affects anybody who goes in and out of Lifespan emergency rooms and hopefully we'll spread that beyond that hospital system. We've got to do our part to bring value to the community, not just to the clients that we have.”