According to AARP, demand for home- and community-based services, such as the Program of All-Inclusive Care for the Elderly (PACE), will likely continue to rise as the number of aging Americans and their need for long-term services and care increases. With this expansion comes opportunities to reduce costs for the programs and improve participant health and well-being by reducing medication risk.

PACE has been instrumental to senior care for decades with a history that dates back to the 1970s, according to the National PACE Association. In 1990, the first programs obtained Medicare and Medicaid waivers to operate, and in 1996, over 20 programs were operational. Today, there are more than 140 programs operating in 30 states. And that growth has the potential to accelerate significantly spurred by tailwinds such as the PACE Plus Act, which is focused on building access to PACE, and the continued widespread interest in aging at home.

PACE participants take, on average, 11 prescriptions in addition to several over-the-counter medications, which are often taken as needed. Taking multiple prescriptions that can interact with each other and have accumulative negative side effects can significantly increase the risk of unintended multi-drug interactions. In addition, over-the-counter drugs, supplements and herbals can also interact with medications, which can result in increased instances of emergency department visits, hospitalizations and other consequences. By employing a modern, sophisticated personalized medication safety management program, PACE organizations can optimize medication regimens, reduce spending and provide an enhanced level of care.

Medication safety reviews for PACE participants

Key to maximizing the benefit of medication risk mitigation is comprehensive medication safety reviews that identify and manage simultaneous multidrug interactions. An important strategy is to first target participants at the highest risk for unintended multidrug interactions. A comprehensive medication safety review can then offer suggestions for clinical interventions to reduce the risk of problems. Many of these can be managed by changing the time that medications are administered to avoid competing medications. What’s more, potential risks can be brought to light at the point of prescribing — before participants ever gain access to medications, driving unneeded medical costs down as a result.

Research co-authored by our team and published in The American Journal of Managed Care compares outcomes for individuals who received their initial medication safety review in 2018, plus at least one additional review in 2019, versus those who did not receive any medication safety reviews.

For the group with the medication safety reviews, the year-over-year change in hospital admissions decreased by 3.4%, but it increased by 6.6% for the group without the reviews. In addition, the group with the reviews recorded a smaller (2.3% vs. 12.6%) year-over-year increase in emergency department visits. The group with the medication safety reviews also had vastly lower year-over-year growth in combined Medicare Part A and Part B medical expenses.

For PACE organizations, clinical decision support can provide a path for limiting medical costs and improving outcomes. These cost savings and enhanced levels of care, among other potential tailwinds, give strength to an already expanding PACE market, paving the way for new growth.

Orsula V. Knowlton, PharmD, MBA, is co-founder and president of Tabula Rasa HealthCare (TRHC), a leading healthcare technology company advancing the safe use of medications. TRHC’s CareVention HealthCare division partners with value-based healthcare organizations like PACE, with offerings such as risk adjustment, personalized medication safety management and pharmacy services, PACE consulting, electronic health record technology solutions, and third-party administration.