Lowering cardiovascular disease risk

It’s no secret that impactful population health initiatives can be difficult to implement. They need active participation from payers, providers, patients, caregivers, pharmacies and a range of other stakeholders to generate compelling evidence that demonstrates the value of bringing an initiative to scale. This support should include high-quality, longitudinal data and an understanding of real-world clinical engagement that can be sufficiently trusted by all parties to tell a comprehensive story about patient care.

Over the past several years, Optum Life Sciences has worked with leading life sciences companies to break down these barriers and pilot a range of innovative population health programs. These programs aim to address challenges like disease prevention, early diagnosis, appropriate treatment selection and ongoing disease management.

Recently, we worked with Amgen, a leading biotechnology company dedicated to improving outcomes for patients with serious illnesses like cardiovascular disease, to pilot a program targeting a perennial population health challenge: lowering cardiovascular disease risk for patients with hyperlipidemia (high cholesterol).

About 38% of U.S. adults have hyperlipidemia, a key risk factor for cardiovascular disease, which is a leading public health crisis in the U.S.¹ Cardiovascular disease costs the U.S. about $219 billion each year, which includes the cost of health care services and medications.² Only 55% of U.S. adults who could benefit from cholesterol-lowering medication currently take these drugs, leaving many patients at risk.³

“Our work with Optum Life Sciences underscores our shared dedication to building evidence-based programs that prioritize patient outcomes,” says Dr. Leandro Boer, vice president, U.S. Medical, General Medicines at Amgen. “Collaboration with industry experts like Optum is essential to creating impactful change and advancing care for the cardiovascular community.”

Managing hyperlipidemia to improve patient outcomes

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  discussions among peers and patients regarding 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.”

Leveraging the provider and patient relationship

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.

Discovering insights to inform future strategies

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. 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

In 2024, the teams assessed effectiveness outcomes. The program had evolved from the success and learnings of its initial stages to create a high touch, personalized, action-oriented program targeting health plan members with a goal to move these members living with hyperlipidemia towards guideline-based care. The teams-based approach applied earlier in the program allowed for bi-directional communication which shed light on the realities of hyperlipidemia treatment and management in the real-world, touching 667 members over the 3-month outreach window using a pharmacist outreach with a ‘next-best action’ recommendation.

The program used a novel approach that included 1) an outreach team with the ability to initiate and engage members in a guideline-based discussion, 2) a pharmacist led discussion with members equipped with medical and pharmacy claims detail to align with guideline-based care; and 3) the infrastructure with the member’s PCP, who made the final decision and took action. 

The program found members who were receptive to this engagement model and were actively involved in shared decision making with their health care provider and outreach team. The outcomes analysis demonstrated promising results for this engagement model to move members towards guideline-based care:

• 93% of contacted members received a guideline-based lipid management recommendation.
• 2.4x more movement toward guideline-based care in test over control populations. Of the 667 members, 26% demonstrated ‘next best action’ movement towards guideline-based care, whereas only 11% of the control population showed movement towards guideline-based care.
• 13.9% increase in LDL-C testing for the test population after the intervention.

The pilot showed the success of a high-touch outreach program that is connected to their physician.  Program findings also yielded additional insights into why members may be struggling with achieving adherence to guideline-based care.

Changing patient behavior is challenging, even with detailed recommendations and claims-based history at hand. The outreach team worked to connect, educate, and motivate members to take action on their health, but more time was needed to help them fully understand their health status. The program focused on guiding members toward the next best steps in managing hyperlipidemia, though ultimately, it is the member’s responsibility to take charge of their own health. Regular engagement is essential to create and maintain accountability, especially for high-risk members. Additionally, understanding and addressing adherence barriers on the provider side is crucial for a comprehensive approach to managing this chronic condition.

1. Centers for Disease Control and Prevention. Cholesterol. Last reviewed October 24, 2021. Accessed January 3, 2022.
2. Centers for Disease Control and Prevention. Health Topics – Heart disease and heart attack. Last reviewed August 17, 2021. Accessed January 3, 2023.
3. Centers for Disease Control and Prevention. High cholesterol facts. Last reviewed October 24, 2021. Accessed January 3, 2022.