Lowering cardiovascular disease risk

Despite clinical guideline recommendations, lipid-lowering therapy (LLT) utilization remains low. There are many reasons for this, but among them are gaps in the care continuum. These include the coordination and follow-up needed to address high lipid levels once they are identified.

To address one of these challenges, Optum Life Sciences and Amgen designed a program to improve awareness of adherence to the American College of Cardiology (ACC) and American Heart Association (AHA) hyperlipidemia clinical guidelines for patients with hyperlipidemia. The initiative involved both primary care provider outreach and increased patient awareness. The program highlighted opportunities for guideline-based care to help providers prioritize provider and patient discussions for treatment and management options.

Statins remain the first line of treatment to lower low-density lipoprotein (LDL, often called “bad” cholesterol). However, some patients may benefit from additional therapies or may require additional labs for ongoing management. The framework for managing patients can quickly become complex.

“Amgen took a collaborative approach to the program. They wanted to do something new in the space with providers instead of a lunch-and-learn or medication adherence program,” says Tina Kelley, senior director at Optum Life Sciences. “Optum then identified health plan leaders and providers who wanted to tackle the same problem with their patient population.”

Optum Life Sciences designed a pilot program leveraging our consultants’ extensive experience working across all parts of the health care ecosystem, our ability to convene different stakeholders from across the enterprise, and our robust real-world data. Supporting information was gathered from January 1, 2020, through May 31, 2022, and included approximately 4,000 patients.

The program was integrated into current health plan communications processes with members and providers. It was comprised of 2 parts:

• Patient mailer:  Members received a personalized mailer to encourage a discussion with their provider regarding their potentially high LDL-C levels at their next appointment. A data-driven assessment of guidelines-based care determined the patients who would benefit from such a discussion.
• Provider information packet:  Providers received information about their patients with hyperlipidemia. This included an assessment of their patient panel aligned with guideline-based care. It was accompanied by specific lists of patients, with recommendations for action and a copy of the patient mailer.

“The program builds on the trusted relationship between a primary care provider and the patient by equipping both of them with information to discuss treatment guidelines for high cholesterol,” says Dr. Brian Solow, chief medical officer of Optum Life Sciences. “Working together, we can identify opportunities to unlock value for the healthcare system, for society and for patients we couldn’t unlock alone.”

Optum Life Sciences experts evaluated the program’s impact through an analysis of its proprietary claims and electronic health record (EHR) data assets. Significant findings included:

• 22% increase in patients treated according to guidelines in the secondary prevention patient group (patients with at least one cardiovascular event, such as a stroke or heart attack)
• 18% reduction in patients receiving no LLT
• About 50% of targeted patients had a care visit after receiving the mailer
• 10x increase in patients with LDL labs on record

Based on these insights and findings, Optum Life Sciences and Amgen entered into a subsequent collaborative effort in 2023 to focus on guideline-based care by engaging more health plan members and enhancing their provider experience. A pod team framework (consisting of a pharmacist, an admin coordinator, and a care coordinator) acted as the interface between patients and individual PCPs to help improve outcomes. While effectiveness outcomes are still being assessed, the outreach portion of the program has been completed. Significant outreach findings include:

• 76% patient call acceptance rate, demonstrating patient willingness and ability to engage
• 91% patient acceptance of the guideline-based care recommendation they received during trusted discussions with their pharmacist

“Collaborating across the health care system in diverse ways, including through analytics to improve patient access and personalized disease management programs, can positively impact the patient care pathway,” Solow says. “Our clients turn to us to execute pilots like the hyperlipidemia program to discover what strategies we can move forward at scale to improve patient outcomes.”

Learn more about how Optum Life Sciences can help design, pilot and scale patient and physician engagement programs.