Launched by CMS in 2017 and funded through 2021, the Million Hearts Model successfully reduced first-time myocardial infarctions (MIs) and strokes in Medicare beneficiaries aged 40 to 79 years, researchers report. “The commitment of health care organizations to cardiovascular risk assessment and follow-up, coupled with payments for risk assessment and reduction, reduced MI and stroke rates,” the authors write. “Results support guideline recommendations for cardiovascular risk assessment.”
The pragmatic, cluster-randomized trial assigned 516 U.S.-based primary care and specialty practices, health centers, and hospital-based outpatient clinics to model intervention or standard care groups. When enrolled in 2017-2018, participants had high or medium cardiovascular disease (CVD) risk (a 10-year predicted probability of MI or stroke [i.e., CVD risk score] ≥15%) but no previous MI or stroke. The intervention group received guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. Organizations were paid by CMS to calculate CVD risk scores for Medicare fee-for-service beneficiaries and to reduce risk among high-risk beneficiaries (CVD risk score ≥30%).
Based on outcomes of first-time CVD events and combined first-time CVD events and CVD deaths through 2021, the studty showed the following: “High- and medium-risk model intervention beneficiaries (n = 130,578) and standard care control beneficiaries (n = 88,286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, −$1.83 per beneficiary per month [90% CI, −$3.97 to −$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, −$16.66 to $20.89]; P = .85).”
Editorial: “There remains a strong need for novel strategies to incentivize the provision of guideline-concordant CVD preventive care to improve CVD outcomes in the US population,” editorialists write. “The encouraging findings from the Million Hearts Model suggest that modernized payment models may be an affirmative strategy to do so, though further work is needed to ensure that these models are patient-centric, optimally deployed, and equity-enhancing.”