Ty Gluckman, M.D., on closing the gaps in lipid testing and treatment | HSES 2026

The biggest gaps between lipid guidelines and practice are undertesting and undertreatment, according to Ty Gluckman, M.D., medical director of the Center for Cardiovascular Analytics, Research and Data Science at the Providence Heart Institute in Portland, Oregon. Gluckman spoke with Managed Healthcare Executive at the 2026 Health System Executive Summit.

“You can’t treat what you don’t test for,” Gluckman said. Testing rates for standard lipid panels are lower than desired, and for risk enhancers such as coronary artery calcium scoring and lipoprotein(a), the main barrier in his experience is that clinicians aren’t ordering the tests, not payer pushback. Guideline writers, he added, share responsibility for making recommendations simple enough to implement. After a change in therapy, the guideline calls for repeating a lipid panel four to 12 weeks later, then every six to 12 months once a patient is at goal, which he said is largely about catching lapses in adherence. Even patients with known elevated levels are undertreated, a gap that has prompted efforts to bring back LDL cholesterol measurement and treatment as national quality measures.

Those gaps are wider for some groups. Disparities in cardiovascular care span sex, race, ethnicity and geography, Gluckman said, and health systems that examine their lipid testing and treatment data will find shortfalls among underrepresented populations and women. Closing them can also help systems build strategies for more equitable care overall.

Prevention needs executive support, he said. Cardiovascular medicine has historically focused on acute care, yet data suggest 80% of cardiovascular disease events are preventable, which requires a commitment from the C-suite to improve the cardiometabolic health of the patients a system serves. He pointed to the recent cardiovascular-kidney-metabolic syndrome guidelines, which span conditions treated by primary care clinicians, cardiologists, nephrologists, hepatologists and others, as a reason to redesign care around the patient. “I think our chronic care management in the United States today is significantly flawed,” he said. “We have a systems-based problem.”

His case to payers and executives is that as organizations take on downside risk through capitation and bundled payments, prevention helps avoid downstream complications, even if the benefits take years or decades to appear. Health systems are often the largest employers in their communities, he added, so investing in prevention is also an investment in their own employees.

In this video, Gluckman discusses where lipid care falls short in practice and why leaders should invest in prevention now.