The 2024 Nudges in Health Care Symposium will take place September 26–27 in Philadelphia. Learn more and register

ASCVD Risk Reduction Initiative

ASCVD Risk Reduction Initiative

Innovation in heart disease prevention

Project status

Pilot/study underway
Pilot/study with results


PI Oversight Committee 

Kevin Volpp, MD, PhD (ASCVD Initiative PI)

Karen Glanz, PhD, MPH 

David Asch, MD, MBA 

Shivan Mehta, MD, MBA, MSHP

Alexander Fanaroff, MD

Mary Putt, PhD, ScD

LauraEllen Ashcraft, PhD, MSW


Clinical Executive Council 

Matthew Press, MD, MSc 

Deborah Driscoll, MD 

C. William Hanson, II, MD 

Frank Ingari 

Raina Merchant, MD, MSHP

Richard Wender, MD


Research Executive Council 

Garret FitzGerald, Mc, FRES 

Dan Rader, MD 

Thomas Cappola, MD, ScM 

Judith Long, MD


Research Operations

Laurie Norton, MA, MBE

Kayla Clark, MPH


Medical Director

Marguerite Balasta, MD

Innovation leads


Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine (Clinical and Translational Science Awards Program of the National Institutes of Health) with institutional support from Penn Medicine


Atherosclerotic cardiovascular disease, or ASCVD, is the leading cause of morbidity and mortality in the United States. A few factors contribute to the problem of ASCVD risk: poor uptake and adherence to medications, persistently unhealthy behaviors, and a system incentivized to treat rather than prevent. What makes this high disease burden particularly frustrating is that many of the important preconditions, like hypertension and hyperlipidemia, are often easy to identify and manage.

Conventional approaches to broad population care gaps often include layering more responsibility on primary care clinicians. Given that primary care clinicians have high and increasing levels of burnout, improving population health may be better achieved by providing operational support so primary care clinicians can do less rather than financial incentives to encourage them to do more.


Given the health and economic benefits of reducing ASCVD risk and the burden posed by conventional approaches, we launched the ASCVD Risk Reduction Initiative in June 2021 to enhance the ways that primary care clinicians help patients improve their heart health. The Initiative is focused on patients with or at high risk of ASCVD.

The ASCVD Risk Reduction Initiative is developing and evaluating a scalable heart disease prevention program that reduces modifiable ASCVD risk. We are designing and testing population health approaches that use best practices in behavioral science and digital health.

Our flagship program is Penn Medicine Healthy Heart, a six-month program aimed at lowering hypertension and hypercholesterolemia. Healthy Heart applies behavioral economics insights to increase uptake of and adherence to evidence-based interventions to reduce ASCVD risk. The goal is to help patients take action to reduce their heart disease risk by lowering their blood pressure and cholesterol from home. The program is also designed to relieve overburdened primary care providers through automated hovering technology coupled with a centralized team of non-clinical navigators and nurse practitioners. We emphasize proactive outreach and prevention outside of a traditional visit model use of data assets to identify and risk-stratify patients.

Current state of ASCVD risk reduction Future state envisioned by ASCVD initiative
Reactive, visit-based model Proactive outreach and prevention using data assets to identify and risk stratify patients in a population health approach
Fee for service Value-based payments plus fee for service
Limited primary care provider (PCP) resources and workforce pipeline Relieve overburdened PCPs using non-clinical navigators, applied informatics tools, and behavioral science best practices
Limited evaluation Ongoing data insights and infrastructure to measure what works, and for whom, to develop insights from populations
Equity at the margins Emphasis on equity in design and evaluation
Strategic partnerships status quo Alignment with Tandigm partnership and expanded relationships with payors, tech, and others



After launching the Initiative in 2021, we built an active learning lab to run pilots and test components of the intervention. Many of our pilot studies are nearing completion. Results and lessons informed the design of Penn Medicine Healthy Heart, which launched in early 2024 at 32 Penn Medicine primary care practices in West and Southwest Philadelphia and Lancaster County. The program will offer blood pressure monitoring and management, cholesterol counseling and medications, healthy eating resources including a custom video series, and smoking cessation aids via text messaging, phone calls, and video.

Way to Health Specs

Learn more about the platform
Activity monitoring
Arms and randomization
Criteria-based rules
Dashboard view
Device integration
EHR integration
Multiple languages
Patient portal messaging
Patient-reported outcomes capture
Photo messaging
Remote patient monitoring
Schedule-based rules
Survey administration
Two-way texting
Vitals monitoring