High costs and insurance prior authorization requirements continue to pose challenges to patient access to novel therapies like newer cholesterol-lowering and heart failure drugs and cardiac procedures related to imaging, cardiac catheterization and more. A new ACC initiative that leverages prospective clinical registry data and partnerships spanning the pharmaceutical and medical device industry, health plans, employers, clinicians and patients aims to change this paradigm and reduce the administrative burden associated with ensuring the most vulnerable heart disease patients have access to medications that can save their lives.

"Advancing quality, equity and value of cardiovascular care is a strategic priority for the College and key to optimizing cardiovascular care and outcomes," said ACC CEO Timothy W. Attebery, DSc, MBA, FACHE. "Changing the narrative around the administrative burden that physicians face in prescribing medications and authorizing cardiac procedures is one giant step toward achieving this vision. We are working with external stakeholders across the health care industry, including medical societies, pharmaceutical companies, employers and pharmacy benefit managers, to implement a more targeted approach to saving lives."

As part of the initiative the College will work with like-minded stakeholders to proactively identify and address the behavioral and system challenges that clinicians and patients face in prescribing novel therapies. Many of these stakeholders have worked with the College over the last year as part of ongoing ACC-led stakeholder discussions around clinical standards, prior authorization and access.

Once fully-implemented, the initiative will prospectively leverage data from ACC's NCDR hospital and outpatient registries, like the PINNACLE Registry, to help clinicians, practices and/or health systems identify what patients are at highest risk of an additional heart attack and who are eligible for newer therapies that could lower their risk. The initiative will provide insights into physician treatment patterns (e.g., adjusting patient doses, following up with lab tests and patient panel intensity) and patient factors (e.g., social determinants, medication burden, comorbidities, etc.). These insights will help practices understand how to address access barriers. In addition, the College and its partners will pilot ways to implement cost-effectiveness through price reductions, reduce administrative burden through policy and automation, support patient activation and adherence through mutual goal setting and action planning, and optimize the right therapy through the targeting of specific high-risk patient cohorts.

"Rather than leveraging broad registry measures that look six months back and an authorization process that waits for patients at risk to present in a practice, this approach looks prospectively at who might be at high risk without treatment and ensures a streamlined pathway to making the treatment available," said Joe Allen, ACC senior director of clinical policy and pathways. "As a result, the impact of cardiovascular disease burden can be reduced in an accelerated timeframe to reach clinical and personal goals for these patients."

The ACC will begin announcing specific programs and partnerships in the coming months that build on the groundwork that has already been laid toward improving access and put into action initiatives that directly help physicians and patients.

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Heart Failure and Cardiomyopathies, Lipid Metabolism, Nonstatins, Acute Heart Failure

Keywords: ACC Advocacy, Health Care Sector, Patient Participation, Cost-Benefit Analysis, Registries, Cardiac Catheterization, Myocardial Infarction, Heart Failure, Cholesterol

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