2026 Southeastern Residency Conference

Background: Value-based care models are growing in popularity. These models follow the logic that healthcare organizations should receive a higher level of reimbursement for providing more effective care. Reimbursement rates are determined by the health systems’ performance on pre-determined patient care metrics. Health organizations can achieve better outcomes while lowering costs through a value-based care model.1 Examples of commonly measured outcomes include A1c, blood pressure, and statin-utilization. Value-based care starts with understanding the shared health needs of your patients and then implementing an interdisciplinary team approach to meet those needs.1 AdventHealth Hendersonville (AHH) is a non-profit health system in Western North Carolina comprising 13 primary care clinics and one main hospital campus. AHH participates in value-based care for patients insured by Medicare through an organization called CHESS, which deploys clinical pharmacists to aid in monitoring their metrics. One metric AHH focused on for 2025 is statin utilization for people with diabetes or atherosclerotic cardiovascular disease (ASCVD) history. Prior studies have demonstrated that cardiovascular disease is the number one cause of death in the world and that statins are largely underutilized by populations that would benefit from them.2 The most common barrier to initiation is patient refusal.2 Pharmacist-led interventions can improve statin utilization metrics.2 The objective of this quality improvement project was to improve statin utilization metrics via pharmacist-led clinic visits at AHH. Methods: A pre-existing registry of 161 Medicare Advantage patients not meeting statin utilization metrics was analyzed for intervention opportunity. The patients included had either a diagnosis of diabetes or history of ASCVD and were not currently taking a statin. Exclusion criteria included prior refusal of service by patient or provider, statin already on medication list, appropriate chart documentation of statin intolerance, and not being a patient of the clinic site anymore. Prior refusal of service was documented in the pre-existing patient registry by CHESS pharmacists. A pharmacy resident reached out via phone to each patient a maximum of three times to attempt to schedule an in person or virtual visit focused on statin initiation or appropriate documentation of statin intolerance. At these pharmacy visits, the pharmacy resident discussed hyperlipidemia, statin use history, and potential adverse effects and use clinical decision making to either initiate a statin or appropriately document true statin intolerance in the record. Results: After removing patients that met exclusion criteria, 30 patients with diabetes and 4 patients with ASCVD history were included (n=34). Of the 30 patients in the diabetes group, 19 were able to be reached by phone (63.3%). After an appointment with pharmacy clinic, 15 of these (78.9%) were able to meet the quality metric, with 2 patients initiated on statin therapy and 13 having statin intolerance appropriately documented in their chart. Of the other 4 patients reached, 1 patient declined statin therapy despite counseling, 1 patient’s primary care provider declined statin initiation, and 2 patients were not indicated for statin therapy. In the ASCVD group, all 4 patients were able to be reached (100%). After an appointment with pharmacy clinic, 2 of these patients (50%) were able to meet the quality metric, with both patients having statin intolerance appropriately documented in their chart. The other 2 patients reached both declined meeting with a pharmacist to discuss cholesterol management. Combining the datasets gives 17 patients updated to meeting the quality metric of 23 patients reached (73.9%) and 34 patients overall (50%). Conclusion: Pharmacist intervention can improve statin utilization metrics for patients with diabetes or ASCVD. Integrating clinical pharmacy into a value-based care model can be beneficial to organizational reimbursement rates due to this improvement in metrics.