Evaluating a Home and Community-based Medication Dispensing Machine: Background and Framework

A background paper that examines the assumptions underpinning a legislatively-mandated pilot study of the effectiveness of in-home automated medication dispensing machines on reducing hospital and nursing home admissions among Medi-Cal beneficiaries

Principal Investigator: Richard Kravitz, MD, MSPH
Funding: California Department of Health Care Services
Report: Medi-Cal MDM Pilot Project: Cost Savings Assessment and Proposed Evaluation Design

Pursuant to enacted legislation, the California Department of Health Care Services was charged with establishing the Home and Community-Based Medication Dispensing Machine (MDM) Pilot Project, which targets fee-for-service Medi-Cal beneficiaries who are at risk of preventable adverse events due to medication non-adherence. The University of California, Davis, working with CAMRI, collaborated with DHCS staff to produce a background paper examining the assumptions underpinning the pilot study, the potential project cost savings, and proposed an evaluation design prior to DHCS implementing this complex and expensive project.

The research team conducted a literature review on known causes of patient non-adherence with medications with a particular focus on Medicaid/Medicare beneficiaries and the role of this non-adherence in increased emergency department visits, hospitalizations, nursing home admissions and related costs. They also defined the Medi-Cal Fee-For-Service (FFS) population most at risk for adverse health events that might be prevented with the use of an in-home MDM.

UC Davis prepared a report describing the baseline costs of the Medi-Cal FFS at-risk population, their related medication non-adherence hospital/nursing home admissions, and the potential cost-effectiveness attributable to the MDM installation. The report includes a recommendation for the design of any future pilot study of the medical and cost-effectiveness of MDM for the Medi-Cal population.