Million Hearts: Cardiovascular Disease Risk Reduction Model

The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model was a randomized controlled trial that sought to bridge a gap in cardiovascular care by providing targeted incentives for health care practitioners to engage in beneficiary CVD risk calculation and population-level risk management. Instead of focusing on the individual components of risk, participating organizations engaged in risk stratification across a beneficiary panel to identify those at highest risk for atherosclerotic cardiovascular disease (ASCVD).

 

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There were 319 participating organizations involved in the Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model. 

Background

The Million Hearts®: CVD Risk Reduction Model supported both the Million Hearts’ goal to prevent one million heart attacks and strokes and CMS’ objective to identify and spread better models of care delivery and payment. This model aimed to improve quality while maintaining budget neutrality for Medicare beneficiaries ages 40-79 who have not had a previous heart attack or stroke.

The Million Hearts®: CVD Risk Reduction Model proposed an innovative way of lowering CVD risks across the population. Currently, health care practitioners are paid to screen for blood pressure, cholesterol, or other risk factors individually. In a new approach, the Million Hearts® CVD Risk Reduction Model used data-driven, widely accepted predictive modeling approaches to generate individualized risk scores and mitigation plans for eligible Medicare fee-for-service beneficiaries.

CMS received a total of 762 applications to participate in this five-year model. After a rigorous review and selection process, 516 organizations were chosen to participate. Randomization resulted in 260 organizations assigned to the intervention group and 256 organizations assigned to the control group. Selected participants were comprised of organizations in 47 states, Puerto Rico and the District of Columbia.

Initiative Details

The Million Hearts® CVD Risk Reduction Model supported prevention of CVD, improved health outcomes, and health care cost savings through systematic implementation of beneficiary risk calculation and stratification. It provided incentives for organizations to calculate risk for all eligible Medicare fee-for-service beneficiaries by using a modified version of the American College of Cardiology/American Heart Association (ACC/AHA) ASCVD ten-year pooled cohort risk calculator to develop risk modification plans based on beneficiary risk profiles. Control practices were not asked to implement the ASCVD risk calculation or evidence-based risk modification but were asked to submit clinical data on all eligible Medicare fee-for-service beneficiaries for comparison against intervention practices.

The target population for the Million Hearts® CVD model were Medicare FFS beneficiaries aged 40-79 years of age who have not had a previous heart attack, stroke, or transient ischemic attack. They could not be in hospice or have End Stage Renal Disease (ESRD).

All Medicare FFS beneficiaries 40-79 years of age that met the inclusion criteria were initially risk-stratified using the ACC/AHA CVD risk calculator. The risk calculator used the following variables to calculate risk:

  • age,
  • race,
  • total and high-density lipoprotein (HDL) cholesterol levels,
  • Low-density lipoprotein (LDL) cholesterol,
  • systolic blood pressure,
  • use of statin therapy,
  • antihypertensive medication,
  • use of aspirin therapy,
  • smoking status, and
  • diabetes status.

This model used a randomized controlled design to identify successful prevention and population health interventions for CVD implemented within the following framework for the intervention group:

  • Universal risk stratification of all Medicare eligible beneficiaries who met the inclusion criteria using the modified version of the ACC/AHA ASCVD Pooled Cohort 10 year risk calculator
  • Evidenced-based risk modification using shared decision making between beneficiaries and care teams in order to reduce ASCVD risk scores
  • Use of prevention and population health management strategies based on needs identified during risk stratification of beneficiaries
  • Reporting of continuous risk calculator variables and ASCVD 10-year risk score through a Data Registry (QCDR) that was provided as part of the model test.

The Million Hearts®: CVD Risk Reduction Model was expected to reach over 3.3 million Medicare fee-for-service beneficiaries and involve nearly 20,000 health care practitioners over a five-year period, beginning in January 2017 and end by December 2021.

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