Multifaceted interventions improve medication adherence and reduce acute hospitalization rates in medicaid patients prescribed asthma controllers

ABSTRACT

Objective: To measure the effectiveness of managed care-led interventions in Medicaid subjects with asthma on medication adherence and acute hospitalization in Pennsylvania. Methods: A total of 3589 members (age range, 5–64 years) served by two Pennsylvania-based Medicaid managed care plans (southeastern Pennsylvania [SEPA] and Lehigh-Capital/New West Pennsylvania [LCNWPA]) with low adherence rates (proportion of days covered [PDC]; 20%–67%) for asthma controller prescription fills in 2012 were guided through a care continuum by a comprehensive asthma strategy, consisting of adherence-improvement interventions (grouped as general intervention [GI] or personalized intervention [PI] for higher-risk subjects). Medication adherence and acute hospitalization rates (emergency department [ED] and inpatient [IP]) were compared at baseline versus one-year post-intervention using paired t-test or signed-rank tests. Repeated measures analysis of variances detected the interaction effect of time by intervention group after controlling for sociodemographic covariates. Results: Member profiles in SEPA (n = 2 796) and LCNWPA (n = 793) were racially and ethnically distinct. Both cohorts experienced statistically significant improvements in mean PDC rate (+4.9% and +7.2%; p = 0.01 and p = 0.03, respectively), accompanied by significant reductions in ED visits (asthma-related: −23.0% and −17.5%, respectively; p < 0.01), and IP admissions (asthma-related: −37.1% and −40.0%, respectively; p < 0.01). The PI subcohorts showed significantly greater improvements in mean PDC versus GI subcohorts (p ≤ 0.04), whereas acute hospitalization rates were statistically comparable in the SEPA cohort, despite its greater asthma burden. Conclusions: Managed care-led interventions can effectively improve medication adherence and reduce acute hospitalizations in high-risk Medicaid populations.

KEYWORDS:

• Emergency department visits
• inpatient admissions
• managed care
• proportion of days covered

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Acknowledgements

The authors wish to thank the Pennsylvania Department of Human Services for its continuing support.

Funding

Financial support for this study was provided by the AmeriHealth Caritas Family of Companies.