Family Heart Foundation Releases Payer Report Cards on LDL-C Control in ASCVD Patients During AMCP 2024

From LDL to Lp(a): Opportunities to Reduce the Rising Tide of Cardiovascular DiseaseThe Family Heart Foundation released data on the control of LDL-C by payer type during a session entitled “From LDL-C to Lp(a): Opportunities to Reduce the Rising Tide of Cardiovascular Events”, featuring Family Heart Board member Dr. Keith C. Ferdinand and Dr. JaMasha Lacy, a pharmacist at Walgreen’s Specialty Pharmacy. This session was sponsored by the Family Heart Foundation and was held during the Academy of Managed Care Pharmacy (AMCP) annual meeting in New Orleans.

The new analysis was based on data from the Family Heart Database™ which examined the percent of people with a diagnosis of atherosclerotic cardiovascular disease (ASCVD), such as MI, stroke, and PAD, who achieved an LDL-cholesterol of <70mg/dl. To be included in this analysis, individuals needed to have a diagnosis of ASCVD and at least one LDL-C measurement in 2021.

From LDL to Lp(a): Opportunities to Reduce the Rising Tide of Cardiovascular Disease

What did we find in this analysis? The table below shows control of LDL-C by payer type for Commercial, Medicare, and Managed Medicaid plans. More than 2.7 million patients with ASCVD are included. Overall, only 25-32% of patients achieved an LDL-C of <70mg/dl and only 11-14% achieved the more aggressive target of <55mg/dl.

Data was also presented on the top 10 managed care plans in terms of % of ASCVD patients with LDL-C < 70mg/dl and that analysis is highlighted in the chart below:

It is interesting to note that even the top performing payer (Tricare West) has <38% of their ASCVD patients achieving an LDL-C of <70mg/dl.


Finally, the Family Heart Foundation reported data on the bottom 10 health plans for achieving LDL-C control in their patients with ASCVD. It is interesting to note that 9 of the 10 poorest performing plans are Managed Medicaid plans and this highlights an opportunity to design and implement interventions to improve LDL-C control in this population.

While there are many potential reasons for the poor performance in terms of controlling LDL-C in high-risk Americans, one significant issue is that the current quality measures from CMS and NCQA/HEDIS are focused on statin prescribing versus LDL-C control. Currently >80% of ASCVD patients are prescribed a statin and hence meet the quality measure but <30% of ASCVD patients have their LDL-C controlled. This disconnect is of paramount importance - payers and HCPs are incentivized based on statin prescribing rather than on ensuring that their patients achieve a safe level of LDL-C. If you are interested in learning more, our Chief Innovation officer Hilly Paige recently wrote a blog on this topic.


Finally, where do we go from here? The Family Heart Foundation recently released a policy paper on specific steps that payers, HCPs, patients, and policy makers can take to improve LDL-C control. And for great tools and resources to help you control your LDL-C, don’t forget to check out the Family Heart LDL Safe Zone!

Leave a Reply