2026 Eastern States Conference

Title: Pharmacist impact on Medicare healthcare effectiveness data and information set (HEDIS) measures in primary care offices
Authors: Hima Dileep, PharmD, PGY-1 Pharmacy Resident, M. Kathryn Goodell, PharmD, BCPS, Shelby Zavala, PharmD
Learning Objective: Identify barriers to implementing a pharmacist led statin care gap program for Medicare
Background Objective: Evaluate the impact of a pharmacist-led service on addressing statin-related care gaps in patients with diabetes and cardiovascular disease to improve adherence to quality measures.
Methods: This multi-center retrospective chart review included patients with diabetes and atherosclerotic cardiovascular disease from primary care offices during the 2025 measurement year. Patients with statin-related care gaps were identified through payor reports, followed by pharmacist-led chart review to confirm eligibility. Pharmacists provided recommendations for statin initiation or optimization and documented interventions, provider responses, and outcomes in the electronic health record. Primary outcome was provider response to recommendations. Secondary outcomes included number of interventions, acceptance rate, patients reached for education, documented exclusions, and cases with no action. Descriptive statistics were used.
Results: A total of 114 patients were identified in the statin use in diabetes measure and 33 in the cardiovascular disease measure. Statin therapy was recommended for 44 (38%) and 5 (15%) patients, respectively, with initiation occurring in 4 and 1 patients. Pharmacists also identified patients requiring exclusion documentation and provided medication education. Exclusions included cirrhosis, dialysis, end stage renal disease, pre-diabetes, pregnancy, lactation, myopathy, rhabdomyolysis. Key barriers included lack of provider follow-up and incomplete documentation. Efforts are focused on improving follow-up processes, reminders, and prescriber education.
Conclusions: Pharmacist-led interventions improved identification of statin care gaps, however, low initiation rates highlight barriers such as inconsistent chart access, limited provider follow-up, and lack of prescribing privileges. These findings support the need for standardized processes, improved communication, and targeted education, as well as use of collaborative practice agreements. Expanding pharmacist integration may improve quality measures, increase statin use, and reduce cardiovascular risk.
Self-assessment question:
Which of the following was identified as a key barrier to statin initiation in this study? (Select all that apply)
A. Inconsistent chart access
B. High medication cost
C. Limited provider collaboration
D. Lack of available statins