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Million Hearts®: Cardiovascular Disease Risk Reduction Model

Million Hearts®: Cardiovascular Disease Risk Reduction Model

Million Hearts®: Cardiovascular Disease Risk Reduction Model


Heart attacks and strokes are a leading cause of death and disability in the United States. Evidence shows that prevention of cardiovascular disease (CVD) can significantly reduce both CVD-related and all-cause mortality. As part of the “better care, smarter spending, healthier people” approach to improving health care delivery, the Million Hearts® CVD Risk Reduction model proposes an innovative way of lowering those risks across the population. Currently, providers are paid to meet specific blood pressure, cholesterol or other targets in their patients. In a new approach, the Million Hearts model® will use a data-driven, widely accepted predictive modelling approaches to generate individualized risk scores and mitigation plans for patients.

The Centers for Medicare & Medicaid Services (CMS) announced a Request for Applications (RFA) for Million Hearts®: CVD Risk Reduction model, herein referred to as the Million Hearts®: CVD Model, an opportunity for healthcare professionals to design sustainable models of care that help reduce 10-year atherosclerotic cardiovascular disease (ASCVD) risk to prevent heart attacks and strokes for tens of thousands of eligible Medicare beneficiaries.

The Million Hearts®: CVD Model is a randomized-controlled trial that seeks to bridge a gap in cardiovascular care by providing targeted incentives for providers to engage in individual CVD risk calculation and population-level risk management. Instead of focusing on the individual components of risk, participating practices will engage in risk stratification across a patient panel to identify those at highest risk for ASCVD.   


The Million Hearts®: CVD Model is authorized under Section 1115A of the Social Security Act (added by section 3021 of the Affordable Care Act), which established the Center for Medicare and Medicaid Innovation (the Innovation Center) to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid, and Children’s Health Insurance Program expenditures while maintaining or enhancing the quality of beneficiaries’ care.


The Million Hearts® CVD Model supports prevention of CVD, improved health outcomes, and health care cost savings through systematic implementation of beneficiary risk calculation and stratification.

The Million Hearts® CVD Model will incentivize practices to calculate risk for all eligible Medicare beneficiaries by using the American College of Cardiology/American Heart Association (ACC/AHA) Atherosclerotic Cardiovascular Disease (ASCVD) 10-year pooled cohort risk calculator and to develop risk modification plans based on beneficiary risk profiles.

The model will use a randomized controlled design to identify successful prevention and population health interventions for CVD implemented within the following framework:

  • Universal risk stratification of all Medicare eligible beneficiaries who meet the inclusion criteria using 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, ASCVD 10-year risk score, and a cardiovascular Physician Quality Reporting System (PQRS) measure set through a CMS certified Data Registry that will be provided as part of the model test. As an added benefit, participating practices will also have the option of reporting on additional PQRS measures within the data registry to meet both the PQRS and Value-Based Modifier (VM) reporting requirements.

Eligible Applicants

The Million Hearts®: CVD Model seeks a diverse range of practices—varying in size, patient case mix, and other patient demographic factors.  An example of the types of practices eligible to apply to participate in the Million Hearts®: CVD Model include but are not limited to:

  • General/family practice, internal medicine, geriatric medicine, multi-specialty care, nephrology or cardiovascular care.  
  • Private practices (must be more than one provider per practice), community health centers and other community-based clinics, hospital-owned physician practices, or hospital/physician organizations.

Approximately 720 practices will be selected from the pool of eligible applicants. Approximately 360 intervention and 360 control group practices will be selected from the final pool of eligible applicants based on the following eligibility criteria:

  • Practice must have at least 1 provider. Providers are defined as Medical Doctors, Doctors of Osteopathic Medicine, Physician Assistants, and Nurse Practitioners.  
  • Practices must be using an Office of the National Coordinator for Health Information Technology (ONC) certified electronic health record system.
  • Participating physician providers or professionals within the practice must have met the criteria for the Medicare EHR Incentive Programs Stage 1, also known as “meaningful use,” of an Office of the National Coordinator (ONC) certified electronic health record.

Core Care Delivery Elements

The model will employ a randomized controlled design and require practices to engage in the following activities:

  • Risk Stratified Care
  • Population Health Management
  • Shared Decision Making
  • Individual Risk Modification Planning
  • Team-Based Care
  • Quality and Clinical Data Reporting

These activities are described in further detail in the Request for Applications (RFA).

Application Process

Interested applicants must submit a non-binding letter of intent (LOI) no later than September 4, 2015. Letters of intent will be used for CMS planning purposes only. Applicants will not be able to access the application without first completing the LOI. Applications must be submitted electronically no later than 11:59 p.m. EST September 4, 2015.  

Application materials can be accessed at

For more information about the Million Hearts® Initiative, please visit


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