JHQ 314: Pharmacist-Led Population Health Initiative to Address Statin Care Gaps: A Quality Improvement Project-JHQ 314 Article

JHQ 314 Article

Pdf Summary

This quality improvement project describes a pharmacist-led population health initiative in a large health system to close statin therapy care gaps tied to Medicare Advantage (MA) value-based care quality measures: Statin Use in Persons with Diabetes (SUPD) and Statin Therapy for Patients with Cardiovascular Disease (SPC). Although statins are strongly recommended by evidence-based guidelines for patients with diabetes and/or atherosclerotic cardiovascular disease (ASCVD), uptake remains suboptimal, and CMS star ratings financially incentivize improved performance. CMS also allows specific annual exclusions, but these require correct documentation and ICD-10 coding; listing “statin intolerance” alone is insufficient.<br /><br />In 2023, the Pharmacy Population Health team used payer claims reports to identify MA patients with SUPD/SPC gaps, prioritized those with upcoming primary care visits and multiple care gaps, and performed manual EHR review to confirm eligibility or exclusion criteria. Pharmacists conducted up to three outreach attempts (phone and sometimes portal messaging), counseled on benefits/risks, and—under a Pharmacy & Therapeutics–approved protocol—could initiate guideline-recommended statins with provider cosignature. They also used EHR tools such as best practice advisories (BPAs), standardized documentation/flowsheets, dashboards, and protocols to order lipid panels when needed.<br /><br />Among 949 unique patients assessed (1,194 documented encounters), 42% met criteria for pharmacist-led statin initiation. Of eligible patients, 22% accepted the pharmacist recommendation, 23% declined, and 55% could not be reached. Common reasons patients did not meet criteria included documented statin intolerance without proper exclusion coding, already having a statin fill, lack of established care within the health system, and missing qualifying diagnoses. Pharmacists frequently closed gaps by addressing adherence and initiating refills, and BPAs were often used to prompt exclusion documentation.<br /><br />The initiative supported improved statin metric performance, but barriers included inaccurate/delayed payer data, high workload from manual reviews, difficulty contacting patients, variable acceptance by patients/providers, and persistent documentation/coding gaps. The authors recommend better exclusion training, adherence-focused strategies, improved data sharing, and broader systemic solutions to enhance sustainability and impact.

Keywords

pharmacist-led population health

statin therapy care gaps

Medicare Advantage star ratings

SUPD measure

SPC measure

atherosclerotic cardiovascular disease (ASCVD)

statin initiation protocol

EHR best practice advisories (BPAs)

ICD-10 exclusion documentation

medication adherence and refill outreach