ASCVD Risk Reduction Initiative
Project status
Collaborators
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
Penn Partners in Care
Penn Medicine Primary Care
Innovation leads
Funding
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
Opportunity
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.
Intervention
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, using digital data and tools 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 |
Impact
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 is offering 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.
Among the ASCVD pilots, one randomized trial found that automated referrals to pharmacy services significantly increased statin prescribing rates for eligible patients overall (from 15 to 32 percent) and at guideline-recommended doses (8 percent to 25 percent). With the automated referral program, pharmacists contacted the patients, discussed the use of statins, and initiated therapy when appropriate.
CHTI is now leading efforts to scale this statin prescribing intervention as Penn Partners in Care Lipid Management. As of October 2024, we have screened nearly 500 patients and appropriately prescribed statins to 30 patients across all Pennsylvania regions of Penn Medicine Primary Care.