The Family Heart Foundation Payer Report Card

It’s been more than ten years since the American College of Cardiology (ACC) and the American Heart Association (AHA) released the 2013 cholesterol guidelines, which reversed 25 years of precedent and removed specific risk-based LDL-cholesterol goals in favor of new guidance recommending initiation of a statin in 4 high-risk “statin benefit” groups, such as those with atherosclerotic cardiovascular disease (ASCVD).

As a result of this new guideline approach, the National Committee for Quality Assurance (NCQA) and the Centers for Medicaid and Medicare Services (CMS) retired their existing LDL cholesterol goal metrics in 2016.

Game Changed.

In its place were new quality measures based on statin prescription and adherence. Therefore, since 2016 health plans and clinician assessments have been based on

“the percentage of males 21–75 years of age and females 40–75 years of age during the measurement year, who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) (denominator) and were dispensed at least one high or moderate-intensity statin medication during the measurement year.”

How are we doing?

An analysis of the Family Heart DatabaseTM looking at the percentage of people with atherosclerotic cardiovascular disease (ASCVD) who had reached the recommended LDL level of 70 mg/dL or lower was completed.

Only 25-32% of patients achieved an LDL-C of

When the benchmark is to “prescribe a statin” and not to “reach the LDL goal,” we are falling short.

at least 80% of ASCVD patients are prescribed a statin however less than 30% of ASCVD patients have their LDL-D controlled.

The Payer Players

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 within our analysis.

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.

The Family Heart Database includes diagnostic data from claims for individuals from the US screened or treated for any form of cardiovascular risk. This analysis includes 197 million people, including 22 million children, from October 2016 through June 2020.