excelleRx has non-hospice experience in managing pharmacotherapy outcomes for patients in the CMS’s Medicare Health Support program (formerly Chronic Care Improvement Pilot program). Hospice Pharmacia has begun to re-think how hospice patients are assessed both upon admission and upon changes in patient symptom status. For the non-hospice program, excelleRx stratifies thousands of patients based on the number of risk factors for medication related problems.

This is done using excelleRx’s unique software decision support tool, AdvisoRx. AdvisoRx uses explicit and implicit criteria to identify patients with actual or potential Medication Related Problems (MRPs). The system uses multifactor screening to identify patients’ risk and stratify them into low, medium, and high-risk categories. The criteria include whether patients are taking or have:
• high-risk medications (e.g. narrow therapeutic index, Beer’s list)
• duplicate therapies
• inappropriate therapies
• diagnoses without being on appropriate therapy (e.g., CHF and no ACEI, beta-blocker)
• drug-drug, drug-disease interactions and interrelations
• individual patient characteristics (gender, co-morbidities, pharmacogenomic indicators)
• polypharmacy indicators (# meds, dosages/day, # prescribers, # pharmacies)
• pertinent medication-related lab values outside defined range

The potential applications for AdvisoRx in the hospice and palliative care populations are tremendous. HP is in the beginning stages of using this system to streamline the admission process for hospices. AdvisoRx may also position hospices to move toward acuity-based scheduling.