The Right Care Initiative: Promoting Accountable Care to Prevent Cardiovascular Death

ABSTRACT

Objective: We describe the rationale for and implementation of the Right Care Initiative and its University of Best Practices (UBP), a model designed to close the implementation gap between clinical evidence and the real-world management of cardiovascular risk factors. The model aims to move beyond institutional silos toward an accountable care model that
emphasizes interorganizational partnerships and the systematic sharing of best practices to eliminate preventable mortality.

Methods: We summarize lessons from a 17-year learning collaborative involving clinicians, pharmacists, health plans, and public health officials. The collaborative focuses on sharing best practices, peer accountability, and the dissemination of team-based care. The article synthesizes evidence from regional pilot projects, performance variation, and federal policy shifts to support a transition to precision prevention.

Results: Effective strategies identified include integrating clinical pharmacists into primary care to manage complex biometrics and utilizing coronary artery calcium imaging for early disease staging. Collaborative learning models address clinical inertia by identifying drug therapy problems and scaling proven interventions, including support for healthy nutrition, weight reduction, and physical activity, across health systems. Aligning value-based payment models with measurable reductions in cardiovascular disease risk holds promise to improve population health.

Conclusion: Making progress toward 0 preventable cardiovascular deaths requires developing organizational infrastructure rather than just generating new science. By fostering radical collaboration and adopting advanced diagnostic and team-based tools, health care leaders can ensure that lifesaving evidence reaches patients effectively.

Am J Manag Care. 2026;32(Spec. No. 9):SP544-SP547.

doi:10.37765/ajmc.2026.90015

The Implementation Gap

The disparity between clinical evidence and real-world practice remains one of the primary challenges to improving population health in the United States. Although decades of scientific progress have provided the tools to prevent the majority of cardiovascular disease,¹ heart disease and stroke continue to be the leading causes of death.² Addressing this crisis requires moving beyond incremental, institution-specific improvements toward a model of accountable care that emphasizes radical interorganizational partnership and the systematic sharing of best patient care practices.³

The implications of this implementation gap reach beyond clinical care. When parents are healthy enough to care for their children and remain active in the workforce, this enhances family prosperity at multiple levels, promoting both emotional well-being and financial stability.⁴ Family stability contributes to healthier communities. In a time of fluctuating workforce participation rates,⁵ addressing the cardiovascular mortality gap should be a high priority to improve the nation’s overall welfare. Investing in the prevention of disability and death is much less expensive for the national treasury than financing the costly care needed after a preventable heart attack or stroke.⁶

The Power of Interorganizational Collaboration

The Right Care Initiative, launched in 2008 by the University of California, Berkeley School of Public Health in collaboration with state officials and the deans of California’s public health schools, was founded to address an urgent public health challenge: the approximately 80,000 Californians who die annually from heart attacks, strokes, and diabetic complications. The initiative operates through 4 regional collaboratives called the University of Best Practices (UBP), located in San Diego, Sacramento, Los Angeles, and the Bay Area. These collaboratives serve as learning laboratories where medical directors, pharmacists, and quality improvement leaders can share results from their internal testing of innovations to reduce cardiovascular risk. The UBP model offers structured learning and provides essential technical assistance, actively engaging health care leaders and clinicians to implement team-based care effectively across a range of organizational structures. Remote UBP sessions have enabled experts and delivery systems to share best practices with participants from 15 countries and 24 US states.

The Right Care Initiative’s UBPs improve transparency and collaboration and prevent institutional isolation, which is a major barrier to accountable care.⁷ Individual practices and health systems are often unaware of breakthroughs achieved by their peers. This disparity is compounded by a systemic delay between the publication of rigorous evidence and its application at the point of care.⁸ The UBP model addresses this gap by creating a structured learning community in which clinicians, pharmacists, health plan administrators, public health officials, and experts regularly convene to share what works. This collaborative approach transforms isolated clinical goals into shared accountability for population health.

The impact of the UBP model was demonstrated by the San Diego UBP pilot project, which was associated with a 22% decline in acute heart attack hospitalizations compared with the rest of California and an estimated $86 million in health care spending.^9,10

These population-level reductions in heart attacks underscore that relatively low-cost interventions focused on knowledge sharing and peer accountability can improve clinical outcomes across diverse populations. The evidence for prioritizing prevention has grown immensely over recent decades, to the point where 80% of cardiovascular deaths are now considered preventable.¹ However, clinical inertia coupled with misaligned incentives results in large numbers of preventable early deaths.¹¹ Improving population health is not simply about generating more science, but rather developing and sustaining the organizational infrastructure to ensure that existing research evidence reaches the right patients at the right time.

Leveraging Team-Based Care

Integrating clinical pharmacists into primary care is an evidence-based lever for closing the implementation gap. Beyond basic medication reconciliation, pharmacists in this collaborative model identify drug therapy problems and optimize complex biometrics management—specifically for blood pressure, low-density lipoprotein cholesterol, and hemoglobin A_1c—the primary drivers of cardiovascular risk. Data from pragmatic trials, such as Hyperlink 3, confirm that patients managed by pharmacists and primary care clinicians achieve blood pressure targets at significantly higher rates than those in traditional care settings.¹² These improvements are achieved through frequent follow-up and telemedicine to provide continuous management.

Despite these clear successes, wide variations in performance across health plans remain a major barrier to health equity. Data from the Healthcare Effectiveness Data and Information Set (HEDIS) show a striking spread between top-performing and bottom-performing organizations on fundamental quality measures.^13,14 This variation represents a preventable gap in mortality. A patient’s risk of a catastrophic event is often determined more by a physician’s practice capabilities than by the availability of effective treatments.¹⁴ An accountable care framework must target these disparities by incentivizing the adoption of proven team-based care models across all payers.

Although organizational infrastructure is foundational to cardiovascular prevention, targeted efforts to enhance patient empowerment and health literacy are also needed to achieve population-level improvements, especially critical for younger populations to establish lifelong preventive habits.¹⁵ Accountable care models should incentivize lifestyle counseling, including support for healthy nutrition, weight reduction, and physical activity,¹⁶ as well as support for medication adherence,¹⁷ to ensure patients have the tools to manage their own risk factors effectively.

Addressing the Screening Paradox

Current national policies reveal a screening paradox that fails to address the magnitude of the cardiovascular burden. In those aged 45 to 64 years, cardiovascular disease claims the lives of men at a rate more than 5 times that of colorectal and prostate cancers combined. For women in the same age group, cardiovascular mortality is more than double the rate of breast and cervical cancers combined.¹⁸ Although the nation has built a robust screening infrastructure for these cancers, we have yet to apply the same level of urgency to detecting subclinical atherosclerosis. By mirroring the proactive model of prevention that our nation successfully deploys against cancer, we can prevent the “grim reaper” of sudden cardiovascular death. Policy leaders have a unique opportunity to advance precision prevention through a new atherosclerotic cardiovascular disease stage I-IV model.^19,20 This model optimizes therapy based on the actual atherosclerotic disease burden, as measured by coronary artery calcium (CAC) imaging, rather than relying solely on traditional, often imprecise risk factors. By staging cardiovascular disease early, clinicians can tailor the intensity of team-based biometric management to the patient’s specific needs,¹⁶ effectively mirroring the proactive “screen and treat” model used in oncology. Using CAC imaging to stage cardiovascular disease provides data for accountable care models to use personalized, high-value interventions that help prevent morbidity and mortality.

Aligning Policy and Accountability

Federal health policies are increasingly enabling accountable care. Accountable care organizations are adopting global payment models to provide financial flexibility to invest in team-based care approaches,^21,22 such as pharmacist-led care and community health worker navigation. When paired with value-based payment models that reward improved patient outcomes, these strategies offer a path toward zero preventable deaths.

CMS adopted several initiatives in the 2026 Physician Fee Schedule that push the boundaries of accountable care. For example, the new CMS Advancing Chronic Care with Effective, Scalable, and Sustainable (ACCESS) model focuses on common conditions such as high blood pressure and diabetes.²³ It rewards organizations based on the share of their population that meets outcome targets.

Increased accountability also requires a deeper integration of behavioral health into primary care.²⁴ Many patients with cardiovascular disease struggle with depression or anxiety, which can hinder their ability to adhere to medication or lifestyle changes.²⁵ ACOs can address this by coordinating care across specialties.²⁶ This whole-person orientation is essential for achieving the “quintuple aim”: better health, better care, lower costs, improved clinician experience, and the advancement of health equity.²⁷ By targeting the wide variations in performance across health plans, as identified in HEDIS data, the Right Care Initiative’s approach directly addresses preventable mortality gaps that disproportionately affect underserved populations.

A Call to Action

Achieving accountable care for population health involves bridging the gap between evidence and action. By promoting collaboration among organizations, encouraging team-based care, leveraging pharmacists’ expertise, and employing advanced diagnostic tools, we can shift our focus from managing cardiovascular disease to preventing it. Evidence from the Right Care Initiative, along with the evolving policy landscape, offers a pathway for action. /

Author Affiliations: Division of Health Policy and Management, School of Public Health, University of California, Berkeley (HPR, HRH, SMS), Berkeley, CA.

Source of Funding: None

Author Disclosures: Dr Rodriguez reports that the Right Care Initiative receives funding from the Novartis Foundation to deliver education and training on evidence-based management of cardiovascular risk factors.

Authorship Information: Concept and design (HPR, HRH, SMS); analysis and interpretation of data (HPR, HRH, SMS); drafting of the manuscript (HPR); and critical revision of the manuscript for important intellectual content (HPR, HRH, SMS).

Address Correspondence to: Hector P. Rodriguez, PhD, MPH, University of California, Berkeley, 2121 Berkeley Way #5427, Berkeley, CA 94720. Email: hrod@berkeley.edu

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