Medicare Star excludes diabetes patients with poor CVD risk factor control

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Published on: June 11, 2012

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Julie Schmittdiel1, Marsha Raebel, Wendy Dyer

  • 1Kaiser Permanente, 2000 Broadway, Oakland, CA 94612.

The American Journal of Managed Care
|March 6, 2015
PubMed

Insights

Medicare Star quality measures for diabetes medication adherence exclude many patients, including those with early nonadherence or insulin use. These exclusions mask high-risk individuals and underestimate nonadherence, impacting cardiovascular disease (CVD) risk factor control.

Area of Science:

  • Health Services Research
  • Quality Improvement
  • Cardiovascular Disease Management

Background:

  • Medicare Star quality measures now include medication adherence for diabetes, hypertension, and hyperlipidemia.
  • These measures exclude patients with fewer than two medication fills (early nonadherence) and those using insulin.
  • This exclusion criteria may impact the accurate assessment of cardiovascular disease (CVD) risk factor control in patients with diabetes.

Purpose of the Study:

  • To determine the proportion of diabetic patients prescribed cardiovascular medications who are excluded from Medicare Star adherence measures.
  • To evaluate the association between adherence (as defined by Star metrics) and exclusion from these metrics with CVD risk factor control.

Main Methods:

  • A cross-sectional, population-based analysis was conducted on 129,040 patients with diabetes aged 65 years or older.
  • Data were sourced from three Kaiser Permanente regions in 2010.
  • Adjusted risk ratios were calculated to assess the relationship between Star adherence, exclusion from Star metrics, and control of glycated hemoglobin (A1C), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP).

Main Results:

  • Twenty-seven percent of diabetic patients on oral medications were excluded from Star metrics.
  • Star-defined nonadherence was linked to poorer control of A1C, LDL-C, and SBP.
  • Exclusion due to early nonadherence or insulin use was strongly associated with poor control of A1C, LDL-C, and SBP.

Conclusions:

  • Medicare Star adherence measures may underestimate medication nonadherence prevalence in diabetes.
  • These measures exclude a significant number of elderly patients with diabetes who are at high risk for poor CVD outcomes.
  • Future quality measures should encompass all patients treated for CVD risk to ensure comprehensive care and accurate assessment.
Abstract

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