Plan helps Florida seniors manage multiple meds

Goal is to reduce complications, hospitalization

Medication management is a major challenge with the Medicare population. Many are on multiple medications. They forget to take their medicine or get confused about what pill to take when and whether they should take it with or without food. Some have visual problems or low literacy levels and can't read and understand the labels.

That's why Sterling Life Insurance Co. implemented a voluntary medication education program for its Medicare Advantage private fee-for-service members in 2006 with a goal of reducing complications and hospitalizations that occur when prescription drugs are taken incorrectly.

"Medication management is very complicated for this population. Our members in the program average five to 15 medications a day and some are taking as many as 28," says Joanne Allison, RN, CCM, PA-C, supervisor of care coordination.

When individuals agree to participate in the program, the nurse care coordinators contact them by telephone and get a list of all the prescription medicines, over-the-counter preparations, herbal remedies, and supplements the member is taking.

The case managers ask the members to bring all their medications to the telephone and read the labels.

"It is important that the care coordinators get an accurate and complete medication list so they take extra time to ensure that all medications are accounted for when they are gathering the information," says Sandy Harnden-Warwick, PT, MPT, GCS, CCM, manager of medical management for Sterling Life Insurance.

The list includes non-prescription medications because some of them react adversely with prescription medications, Allison adds.

"When we explain to the members that the supplements they are taking may interfere with what their physician is prescribing, they are more likely to give us the list of all their medications," she says.

The case managers use a software program that cross-matches medications to see if any of them interfere with each other.

The case managers fax a copy of the members' medication lists to the primary care physician to verify that the information the member gave them is correct. They send the members educational materials about all of the items on the medication list.

When they make follow-up calls to the members, the care coordinators discuss the reason each medication was prescribed, how it should be taken, and go over potential side effects.

They ask questions about compliance such as: Do you stop the medication when you feel better or feel worse? Do you use someone else's medication? Do you have problems getting your medication?

They encourage the members to talk to their physician about their medications if they have questions or concerns. They identify barriers to medication compliance and help the member find solutions. For instance, if members can't afford the medicine, the care coordinators will suggest that they talk with their doctor about generic drugs or help them identify resources that can assist with the cost.

When members appear to have serious problems understanding their medication regimen, the Sterling case managers identify someone in the community — a pharmacist or nurses in a doctor's office — who help the members learn to manage their medication.

In some cases, they identify someone who can actually go into the members' homes and set up the medication for them.

"Our philosophy is that better-informed consumers make better choices. With the case management process, we work to provide education that will facilitate better care," Harnden-Warwick says.