New Komodo Health Analysis Finds Significant Variation in Treatment for People with Rheumatoid Arthritis
Komodo’s Latest QE Report for CMS Finds Patients’ Insurance Type Plays a Major Role in DMARD Dispensing Patterns, and Many Patients are Prescribed Opioids for Pain Management Without Effective Control of Inflammation
Rheumatoid arthritis (RA) is a chronic condition in which a patient’s own immune system attacks the tissues lining their joints and other organs, causing inflammation, pain, and swelling. Over time, the inflammation can produce deformity and destruction of joints and can significantly limit the ability of the patient to complete normal activities. The condition affects roughly 1.3 million adults in the U.S., with disproportionate impacts on certain subsets of the population. Women are two to three times more likely to be affected than men, and evidence suggests that Black and Hispanic patients may experience more severe symptoms or long-term disabilities compared to individuals in other racial and ethnic groups.
While clinicians and scientists do not have a complete understanding of the factors that contribute to these differences in disease activity or long-term outcome, there are many medications that have the potential to slow the progression of RA. This group of medications is known broadly as Disease Modifying Anti-Rheumatic Drugs (DMARDs).
Although evidence shows that DMARDs can control symptoms and slow the progression of joint disease, a new analysis conducted by Komodo Health finds that just over half (54%) of patients with RA received these drugs during the measurement period. Moreover, DMARD dispense rates varied widely depending on the type of insurance the patient had and where the patient lived.
The analysis was conducted using Komodo’s Healthcare Map™ and the Centers for Medicare and Medicaid Services (CMS) Medicare fee-for-service data set under the CMS Qualified Entity Program (QECP). This report is part of a larger set of initiatives to measure and quantify the extent to which patients with chronic and debilitating conditions receive evidence-based diagnostic and therapeutic interventions and whether they also are being monitored for specific side effects or risks relating to the use of certain therapies.
To conduct the analysis, Komodo evaluated DMARD dispense rates using a Healthcare Effectiveness Data and Information Set (HEDIS®) standard measure, reporting on measurement year 2017.Following were some of the key findings:
- 54% of Patients Received Anti-Rheumatic Drugs: Among the 1,185,147 RA patients in the eligible population, approximately 54% were prescribed and had dispensed at least one DMARD sometime during the measurement year.
- Medicare Advantage Patients Were 1.5 Times More Likely to Receive Drugs: DMARD dispense rates varied significantly depending on the type of insurance that a patient had. The highest dispense rate was observed in the group of patients in the Medicare Advantage category. The lowest dispense rate was observed in the group of patients in the Medicaid Managed Care category. Compared to RA patients enrolled in a Medicaid Managed Care plan, Medicare Advantage patients were 1.5 times more likely to be dispensed a DMARD.
- Patients in Puerto Rico and Rhode Island Were Least Likely to Receive DMARD Treatment: DMARD dispense rates also varied significantly depending on a patient’s state or territory of residence. The report found a 38.2% difference between the state with the highest DMARD dispense rate (Minnesota) and the lowest dispense rate (Puerto Rico). Other states and districts with particularly low screening rates were Rhode Island (45.3%), Washington, D.C. (47.7%), and Hawaii (48.2%). These dispense rates reflect the experience in the combined all-payer mix of patients in each state or territory.
- Opioid Analgesic Dispense Rates High in Patients Not Receiving DMARD Therapy: Komodo also evaluated patterns of opioid use in RA patients not receiving evidence-based DMARD therapy. Opioid prescribing was common in the RA population, but dispense rates were highest in the Medicaid-Medicare dual eligible cohort (~66%). More significantly, the report found that in both the Medicaid Managed Care population and the Commercial population, a significant proportion of patients were prescribed opioids without effective control of inflammation (opioid + no DMARD dispensed).
Several factors may be influencing the high DMARD dispense rate in the Medicare Advantage population. Among them, the report cites incentives provided by Medicare Advantage organizations to participating providers in an effort to optimize performance around this HEDIS metric; policy changes tied to the Patient Protection and Affordable Care Act (ACA), which had the potential to reduce financial barriers to accessing DMARDs for Medicare beneficiaries enrolled in a 2017 Part D plan; and several variables unique to Medicaid, which could be affecting the low dispense rates observed in the Medicaid Managed Care cohort.
The report also emphasizes the need for ongoing monitoring of medication management in the RA population given the findings relating to opioid use without effective DMARD therapy.
To view the full report, click here.