Health Care Systems Research Network (HCSRN) Conference April 12, 2018 Minneapolis, MN

Transcription

1 Health Care Systems Research Network (HCSRN) Conference April 12, 2018 Minneapolis, MN

2 Impact of the Latest USPSTF Recommendations for Statin Use for Primary Cardiovascular Prevention on Payers and Care Systems JoAnn Sperl-Hillen, Lauren Crain, Karen Margolis, Patrick O Connor, Tom Kottke, Sue Cooper, Dan Rehrauer, Pete Marshall

3 Background The USPSTF updated its 2008 recommendation for statin use for primary prevention in November 2016 Statins are recommended by USPSTF for adults age without a history of CVD who have 1 or more CVD risk factor and a 10-year CVD risk of 10% or higher (Grade B recommendation) The Affordable Care Act requires insurers to cover Grade A & B recommendations for primary prevention without patient cost sharing (no co-payments) The potential impact of this to payers and care systems is of interest

4 JAMA. 2016;316(19): doi: /jama

5 JAMA. 2016;316(19): doi: /jama

6 Statins are cost effective In populations at low risk of harms from statin use and unburdened by chronic pill use, broader use of statins would both avert substantive cardiovascular morbidity and prove cost-saving, even when baseline cardiovascular risk is low. Heller, Coxcon, Penko, et al. Evaluating the Impact and Cost-Effectiveness of Statin Use for Primary Prevention of Coronary Heart Disease and Stroke. Circulation Sep 19;136(12): doi: /CIRCULATIONAHA

7 Previously published cost-effectiveness data Heller, Coxcon, Penko, et al. Evaluating the Impact and Cost-Effectiveness of Statin Use for Primary Prevention of Coronary Heart Disease and Stroke. Circulation Sep 19;136(12): doi: /CIRCULATIONAHA

8 Our study objective Take advantage of existing data sources that include ASCVD risk calculations to estimate how many people meet the USPSTF criteria for statin use Estimate the cost of statins for the eligible patient and member populations

9 Study methods Real time EHR encounter data was collected through a clinical decision support tool called CV Wizard used at all primary care visits at 2 large care systems (HP and Park Nicollet) and saved in analytic data repository Patients age with encounters between June 1, 2016-May 31, 2017 were included in this analysis CV risk factors included diabetes condition (identified through a validated algorithm), hypertension condition (through problem list and diagnostic codes) current smoker, or dyslipidemia (defined as LDL >=130 mg/dl or HDL <=40 mg/dl) Current statin use was also captured Algorithms were applied to each patient s last encounter determine if USPSTF criteria were met for statin use based on one identified CV risk factor and 10-year ASCVD risk >=10%

10 CV Wizard Tool used for Clinical Decision Support Provider version of Clinical Decision Support (CDS) display for a fictitious patient. This is displayed on the EHR screen then printed by the rooming nurse and placed on the exam room door for rapid review by the provider just before the start of the visit. Uncontrolled CV risk factors are prioritized by the potential absolute risk reduction that may be achieved by management of that risk factors.

11 Main results Unique individuals age N=207,163 DM 12.2% HTN 31.2% Tobacco 10.6%, Dyslipidemia 33.6% >= 1 CV risk factor 119, 786 (57.8%) 5,809 (2.8%) excluded due to known CV disease 81,568 (39.4%) excluded due to no CV risk factor identified Statin recommended per USPSTF recommendations N=49,815 (24%) 10-year ASCVD risk >=10% on a statin 13,594(6.5%) 10-year ASCVD risk >=10% not on a statin 32,579(15.7%) 10-year ASCVD risk % on a statin 3642 (1.7%)

12 Estimated cost of statins At least 24% of adults age meet criteria for statins, adults age make up about 40% of the population Average cost of a statin $60 annually per person (based on health plan costs of atorvastatin $5/month, simvastatin $2/month, rosuvastatin $11/month) Estimated cost to pay for statins for within a large primary care system with 500,000 patients (all ages)- $3M Estimated cost to pay for statins for 1.5 members within a large health plan - $10 Million Does not include costs related to additional office visits, labs, drug side effects. Current costs are not this high because only ¼ of patients of eligible patients are currently on a statin.

13 Health insurer compliance Compliance with the law is necessary. Services covered as preventive services are derived from the Patient Protection and Affordable Care Act requirements which include the US Preventive Services Task Force, A and B Recommendations Identifying individual members who meet criteria for primary prevention using claims data is difficult Covering all patients in the age group would add even more drug costs Covering statins for primary prevention but not secondary prevention could seem problematic/odd to patients

14 HealthPartners strategy HealthPartners will approve coverage at preventive benefit ($0 co-pay) when requested (effective 11/1/17) The benefit is publically reported to members- criteria/policy.html?contentid=entry_ Eligibility is confirmed by a provider using a prior authorization form that includes a simple provider attestation: That the member has no history of cardiovascular disease (CVD), and Member has one or more CVD risk factors, and Member has a 10-year risk of a cardiovascular event of 10% or greater, per the ACC/AHA risk calculator

15 Conclusion Statins for primary prevention are generally considered cost-effective and of substantial net clinical benefit 25% of all individuals age meet USPSTF criteria for statin use for primary prevention, and only ¼ of them are on a statin Many operational and cost challenges exist to care systems and insurers to providing this service to patients