Million Hearts® Cardiovascular Disease Risk Reduction Model
Heart attacks and strokes are the first and fifth leading causes of death, and major contributors to disability, in the United States. Evidence shows prevention of cardiovascular disease (CVD) can significantly reduce both CVD-related and all-cause mortality. As part of the Administration’s “better care, smarter spending, healthier people” approach to improving health care delivery, the Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model proposes 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 will use data-driven, widely accepted predictive modeling approaches to generate individualized risk scores and mitigation plans for eligible Medicare fee-for-service beneficiaries.
Last year, the Centers for Medicare & Medicaid Services (CMS) announced a Request for Applications (RFA) for the Million Hearts® CVD Risk Reduction Model. The model is an opportunity for health care professionals to design sustainable models of care that help reduce the ten-year atherosclerotic cardiovascular disease (ASCVD) risk and to prevent heart attacks and strokes for tens of thousands of eligible Medicare beneficiaries.
The Million Hearts® CVD Risk Reduction Model is a randomized controlled trial that seeks 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 will engage in risk stratification across a beneficiary panel to identify those at highest risk for ASCVD.
CMS received a total of 762 applications. After a rigorous review and selection process, 516 organizations were chosen to participate in the model. Applications for the model were reviewed for completeness and eligibility of the responses to the required RFA questions. Applicants were not selected for the following reasons (as defined in the RFA): they did not meet the model eligibility requirements for having at least one practitioner; they did not provide adequate responses for RFA questions related to Team Based Care and Shared Decisions; or they did not submit the required documents to secure their place in the model.
To view a list of the 516 participants in the Million Hearts® CVD Risk Reduction Model, please visit: https://innovation.cms.gov/initiatives/Million-Hearts-CVDRRM/.
Randomization resulted in 260 organizations assigned to the intervention group and 256 organizations assigned to the control group. The Million Hearts® CVD Risk Reduction Model is comprised of organizations in 47 states, Puerto Rico, and the District of Columbia, and is expected to reach over 3.3 million Medicare fee-for-service beneficiaries and involve nearly 20,000 health care practitioners. The model will last five years.
The Million Hearts® CVD Risk Reduction Model includes a diverse range of organizations—varying in size, beneficiary case mix, and other beneficiary demographic factors. An example of the types of organizations participating in the model include but are not limited to:
- General/family practice, internal medicine, geriatric medicine, multi-specialty care, nephrology or cardiovascular care
- Private practices, community health centers and other community-based clinics, academic/university health centers, hospital-owned physician practices, and hospital/physician organizations.
The Million Hearts® CVD Risk Reduction Model supports prevention of CVD, improved health outcomes, and health care cost savings through systematic implementation of beneficiary risk calculation and stratification. It will provide incentives for organizations to calculate risk for all eligible Medicare fee-for-service beneficiaries by using 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.
The model will use 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 eligible Medicare fee-for-service eligible beneficiaries who meet the inclusion criteria using the ACC/AHA ASCVD pooled cohort ten-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 ten-year risk score for each enrolled beneficiary through a Data Registry that will be provided as part of the model test.
Control practices will not be asked to implement the ASCVD risk calculation or evidence-based risk modification but will be asked to submit clinical data on all eligible Medicare fee-for-service beneficiaries for comparison against intervention practices.
The Million Hearts® CVD Risk Reduction 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 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.
For more information about the Million Hearts® Cardiovascular Disease Risk Reduction Model, please visit: https://innovation.cms.gov/initiatives/Million-Hearts-CVDRRM/.
For more information about the Million Hearts® Initiative, please visit http://millionhearts.hhs.gov/.