Aging is a privilege, not a guarantee–Chronic Care Management improves quality of life
By Marshall Eidenberg, DO, MBA
As one has the privilege to get older, chronic conditions will go up. Typically, one per decade after one’s 30s. Each situation typically involves one or more medications for each chronic health condition. And with more medicines, the risk of interaction and adverse drug events increases. A key component of improving lifespan and healthspan is managing these combined effects. Using a Chronic Care Management service (CCM), particularly one focusing on medications, can improve health outcomes and decrease cost across the healthcare spectrum.
As a young physician training in emergency medicine, I had a patient present with confusion, GI symptoms, vision changes where lights had a greenish tint, and a slow heart rate. The patient’s history included cardiac disease and a recently diagnosed cancer. Ultimately, the person was diagnosed with digoxin toxicity due to renal complications of their newly diagnosed renal cancer and taking herbal preparation for cancer rather than chemotherapy. If the patient had a CCM service available, including pharmacists, I would not have cared for that patient in the ER that day. Since this patient had multiple conditions, they would have qualified for CCM benefits. Discussing what was going on with a pharmacist may have identified a complication earlier and prevented the patient’s hospitalization and death later that day.
In January 2015, the Centers for Medicare & Medicaid Services (CMS) introduced Chronic Care Management (CCM) service. In a report by Schurrer et al. (2017)3, there were multiple good outcomes found from CCM. These include improved patient adherence to medication therapy, decreased hospitalizations and ER visits, and increased efficiency in the daily clinical practice. Because the more complex patients had multiple touchpoints between visits, they were less likely to backslide between appointments. The downside to this was while there was some payment, the reimbursement was not adequate for the CCM work required. Today a turnkey solution like PharmD Live® can benefit your patients and practice. You can do good for your patients and do well financially by eliminating startup and administration costs.
Looking at the healthcare system as a whole, in a study by Al-Qudah et al. (2019)1, by using clinical pharmacists to prevent Treatment-Related Problems (TRPs) leads to the benefit of almost 6 times the cost of the program because of intervention and avoiding preventable Adverse Drug Events (ADEs). The use and value of pharmacists has long been known. Even back in 1997, before CCM started, a study by Hanlon et al.2 discussed “predictable ADEs are common in high risk older outpatients, resulting in considerable medication modification and substantial healthcare utilization.” Adverse events can result from age-related changes in pharmacodynamics and pharmacokinetics, leading to more orthostatic hypotension, more falls, more gastrointestinal or intracranial bleeding, and more delirium events.
By using a CCM service, especially one based on pharmacist intervention, a clinic can improve patient engagement by supporting self-care management. Medicine is a team activity focused on the patient. When patients are made aware of the interplay of their specialists, medications, and how their actions affect their health, their pharmacist’s brief and recurring touchpoints can improve their quality of life.
In conducting standard coordination services offered through CCM, activity updates with one specialist are reviewed against all, and a pharmacist coordinator can assess and alert all if these treatments conflict. Further, the CCM process can increase the use of community-based services because of increased recognition of unmet needs, reducing the use of acute care services. And the longer one is receiving CCM services, the greater the benefit. The study by Schurrer et al. (2017)3 saw dramatic decreases in hospitalization and ER visit rates, along with outpatient and inpatient Medicare expenditures, when comparing 18 months vs. 6 months of CCM services.
PharmD Live Chronic Care Management Services works toward better compliance with your therapeutic interventions. Enter a cost-effective partnership with us for your delivery of care.
Regional Medical Director, PharmD Live
Dr. Eidenberg has made his mark as a chief medical officer in harsh conditions. Marshall is a board-certified emergency medicine physician interested in trauma, improving efficiency and flow, and wellness in the community and healthcare settings. He graduated with a bachelor’s in Biology from Western Maryland College and earned his medical degree from the Philadelphia College of Osteopathy. Dr. Eidenberg additionally received a Healthcare Management MBA from Walden University.
Sources
- Al-Qudah, R. A., Al-Badrriyeh, D., Al-ali, F. M., Altawalbeh, S. M., Basheti, I. A. (2019). Cost-benefit analysis of clinical pharmacist intervention and preventing adverse drug events in the general chronic diseases outpatients. Journal of Evaluation in Clinical Practice. https://doi.org/10.1111/jep.13209.
- Hanlon, J. T., Schmader, K. E., Koronkowski, M. J., Weinberger, M., Landsman, P. B., Samsa, G. P., Lewis, I. K., (1997). Adverse drug events in high-risk older outpatients. Journal of the American Geriatrics Society, 45:945-948. Retrieved from https://www.researchgate.net/publication/13963053_Adverse_Drug_Events_In_High_Risk_Older_Outpatients on 18 February 2022.
- Schurrer, J., O’Malley, A., Wilson, C., McCall, N., Jain, N. (2017). Evaluation of the diffusion and impact of chronic care management (CCM): Final report. Mathematica Policy Research. Retrieved from https://innovation.cms.gov/files/reports/chronic-care-mngmt-finalevalrpt.pdf on 15 February 2022.
