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Deprescribing in Advanced Illness: Aligning Patient, Clinician, and Health Plan Goals

  • Natasha ParekhEmail author
  • Yael Schenker
  • Chester B. Good
  • Lynn Neilson
  • William H. Shrank
Perspective

Abstract

Polypharmacy has been linked to adverse outcomes including increased risk of hospitalization, falls, and death and contributes to unnecessary healthcare spending. Deprescribing efforts aim to reduce medication burden while improving or maintaining patients’ quality of life. While the practice of deprescribing is gaining momentum, quality measurement and provider reimbursement are barriers that must be addressed for deprescribing to achieve widespread adoption. Because many quality measures are focused on medication use and adherence, deprescribing efforts may negatively impact primary care provider and health plan quality ratings and value-based reimbursement. In addressing this conflict, there are opportunities to proactively align the priorities and incentives of patients, providers, and plans to promote deprescribing. In this report, we propose several actionable steps to address quality and reimbursement-based barriers such as facilitating the exclusion of those engaged in deprescribing efforts from quality measures and the development of deprescribing-based quality measures.

KEY WORDS

deprescribing polypharmacy pharmaceuticals quality measures 

Notes

Compliance with Ethical Standards

Conflict of Interest

Natasha Parekh, Lynn Neilson, Chester Good, and William Shrank are employed by the UPMC Insurance Services Division.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Natasha Parekh
    • 1
    • 2
    • 3
    Email author
  • Yael Schenker
    • 2
    • 4
  • Chester B. Good
    • 1
    • 2
    • 3
  • Lynn Neilson
    • 1
    • 3
  • William H. Shrank
    • 1
    • 3
  1. 1.Center for Value-Based Pharmacy InitiativesUPMC Insurance Services DivisionPittsburghUSA
  2. 2.Division of General Internal MedicineUniversity of PittsburghPittsburghUSA
  3. 3.UPMC Insurance Services DivisionPittsburghUSA
  4. 4.Section of Palliative Care and Medical Ethics, Division of General Internal MedicineUniversity of PittsburghPittsburghUSA

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