(38) Payer analysis of cholesterol management in US individuals with atherosclerotic cardiovascular disease during 2023: A study from the Family Heart Database®

Background: : Individuals living with atherosclerotic cardiovascular disease (ASCVD) need optimized LDL-C lowering therapy to achieve evidence-based LDL-C goals. The current NCQA/HEDIS cholesterol quality measure focuses only on statin use which is insufficient to ensure appropriate LDL-C goal achievement. Payer type may impact achievement of LDL-C targets in this population at increased risk for recurrent events.

Objective: : To measure payer-specific population-based LDL-C goal achievement to elucidate gaps in care providing clinically meaningful information beyond the current statin-based quality measure.

Methods: : Retrospective cohort study of the Family Heart Database of individuals with ASCVD prior to January 2023 with at least one medical claim (including paid, abandoned or rejected) and LDL-C measurement within 2023. Primary measures included mean LDL-C and percent of treated population at goal LDL-C of < 70 and < 55 mg/dL across payers. Major payment categories (Commercial, Medicare, Managed Medicaid, Medicaid, Assistance Programs, and Cash) were identified from medication claims. If multiple medication claims indicated more than one payment category, the individual was represented in both categories.

Results: : Adults (n= 3,217,634) with ASCVD; mean age 67.4 years, 48.2% women, 10.6% Black and 11.1% Hispanic individuals. Mean LDL-C was 88.2 mg/dL, with LDL-C < 70 and < 55 mg/dL goals achieved in 33.6% and 15.6% of the population respectively. Mean LDL-C, and percent of the treated population with LDL-C < 70 and < 55 mg/dL varied across payment types as follows from relative best to least favorable: Medicare (84.9, 36.8, 17.1), Assistance Programs (89.9, 32.4, 5.2), Cash (90.6, 31.5, 14.7), Commercial (91.6, 30.3, 14.0), Managed Medicaid (92.2, 29.5, 13.2), Medicaid (95.2, 26.9, 12.5). LDL-C population-based goal attainment for LDL-C < 70 and < 55 mg/dL also varied across specific health plans within each category with relative best achieved: Commercial-Tricare West Health Net Federal Services (42.2, 21.1); Medicare-United Health Rx AARP (40.1, 19.0); Managed Medicaid-MEDI-CAL (39.0, 18.7).

Conclusions: : In this cohort of 3.2 million US individuals with ASCVD achievement of evidence-based LDL-C goals remains suboptimal. There is notable variability in these measures across payer types and across specific health plans within each category. Identifying payer-specific variability of goal achievement, gaps in care, as well as establishment of a specific LDL-C goal-based quality measure may provide opportunities to reduce event rates in this at-risk population.

Sponsorship:: Family Heart Foundation.