On May 28, 2015, Health and Human Services Secretary Sylvia M. Burwell announced a new initiative by the Centers for Medicare & Medicaid Services (CMS) aimed to reduce the risk of cardiovascular disease (CVD) among Medicare beneficiaries over the course of the next five years. The initiative, called the Million Hearts CVD Risk Reduction Model, seeks to prevent one million heart attacks and strokes by 2017 while simultaneously testing an innovative new approach to CVD risk reduction, in the hopes that it will provide better health outcomes for patients while reducing Medicare expenditures.
The focus on reducing Medicare expenditures in the coming years makes CVD an especially important health issue to address. According to an analysis by Definitive Healthcare, in 2013 Medicare made payments worth $5.2 billion to hospitals for the treatment of heart attack, heart failure, stroke and hypertension-related diagnoses. Many of these hospitalizations are likely preventable with proactive, preventive care focused on evaluating and addressing an individual’s risk factors for CVD. With an initial enrollment goal of 300,000 Medicare beneficiaries and 720 healthcare providers, this is exactly the type of care that CMS hopes to implement with Million Hearts.
A Break with the Current Model
Million Hearts was developed within the Center for Medicare and Medicaid Innovation, or the CMS Innovation Center, whose stated goal is “the development and testing of innovative health care payment and service delivery models.” With this goal in mind, it is no surprise that Million Hearts represents a departure from the traditional model for reducing CVD risk, which compensates healthcare providers for meeting pre-determined blood pressure and cholesterol targets for their patients as a group. This approach ignores the individualized risk factors that contribute to CVD, and as a result, may not be the most effective method for reducing the risk of heart attack or stroke.
Million Hearts will instead compensate providers for working individually with high risk patients to develop a unique plan of action aimed at reducing the risk of CVD. Participating providers will determine each patient’s 10-year risk of heart attack or stroke using a risk calculator developed by the American College of Cardiology and the American Heart Association. Providers will then work with high risk patients (those with a 30% or higher chance of heart attack or stroke within the next 10 years) to develop an individualized plan of action, including things such as blood pressure and cholesterol reduction, smoking cessation and increased exercise. In turn, providers will be compensated based on their ability to reduce the absolute risk of heart attack or stroke among their high risk patients.
Randomized Trial Design
Million Hearts will run as a randomized trial. Half of participating providers will be randomly assigned to an intervention group, with the other half assigned to a control group. The intervention group will implement the risk assessment and individualized plan of action approach, while the control group will simply be asked to provide clinical data on patients throughout the duration of the trial, without altering treatment methods.
The goal of Million Hearts is to see a statistically significant reduction in the number of heart attacks and strokes, as well as to reduce expenditures on costly treatments by identifying and addressing causes of CVD before they result in heart attack or stroke.
Application and Enrollment Process
In order to meet the enrollment targets for Million Hearts, CMS is seeking the participation of a variety of healthcare practices, including general/family practice, internal medicine, geriatric medicine, multi-specialty care, nephrology and cardiovascular care. Eligible practices must have at least one provider and use an Office of the National Coordinator certified Electronic Health Record system.
Interested practices must submit a letter of Intent followed by an application to CMS by September 4, 2015. Letters of intent may be submitted now; applications will be made available on July 6, 2015.
A New Approach for the Future
Million Hearts is an exciting new initiative that has the potential to change the way healthcare providers assess, prevent and treat the risk of cardiovascular disease. Definitive Healthcare is eager to follow this program as it progresses over the next five years. Definitive Healthcare's online healthcare database is uniquely positioned to track any developments and outcomes from the Million Hearts program; within our Physicians database, we have already made note of 361 physicians who are participating in Million Hearts. Definitive Healthcare will continue to track and analyze the results from this, and other new developments in the healthcare industry.