On July 21, CMS announced the names of 516 practices(data.cms.gov) -- including scores of family medicine offices -- in 47 states, Puerto Rico and the District of Columbia that will be participating in its Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model(innovation.cms.gov). The program seeks to decrease cardiovascular disease risk in the Medicare fee-for-service beneficiary population by assessing patients' risk for heart attack or stroke and applying preventive interventions.
"Our health care system historically often emphasized acute care over preventive care," said Patrick Conway, M.D., CMS acting principal deputy administrator and chief medical officer, in a July 21 news release(www.cms.gov). "This initiative will enhance patient-centered care and give practitioners the resources to invest the time and in staff to address and manage patients who are at high risk for heart attacks and strokes."
In the current Medicare system, health care professionals are paid to screen blood pressure, cholesterol and other risk factors individually. But in this new approach to care, participating physicians will use data-driven, widely accepted predictive modeling to generate personalized risk scores and develop specific plans in partnership with patients to reduce their risk of heart attack or stroke.
- On July 21, CMS announced the names of 516 practices -- including scores of family medicine offices -- that will participate in its Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model.
- Nearly 20,000 health care professionals and more than 3.3 million Medicare fee-for-service beneficiaries will participate in the five-year randomized, controlled trial.
- For practices in the intervention arm, the model will offer incentives to calculate CVD risk for all eligible Medicare beneficiaries and to develop risk-modification plans based on beneficiaries' risk profiles.
In late May 2015, HHS Secretary Sylvia Burwell introduced(www.hhs.gov) the Million Hearts CVD Risk Reduction Model, saying it "recognizes that giving doctors more one-on-one time with their patients to prevent illness leads to better outcomes and that greater access to health information helps empower patients to be active participants in their care."
Darshak Sanghavi, M.D., director of the Preventive and Population Health Care Models Group at CMS' Center for Medicare and Medicaid Innovation (Innovation Center), told AAFP News last June that the Million Hearts model is the first to look at specific predicted outcomes while incentivizing risk-reduction across the board.
The model does this by examining individual risk-reduction interventions and calculating how much each one affects the patient's health, said Sanghavi. For example, one intervention might reduce the risk of heart attack or stroke from 35 percent to 22 percent but another might only reduce risk by 2 percent. Thus, he said, the first option might take priority as a result of the model's calculation.
"The model empowers both the patient and the physician to understand the risk and then take action to manage that risk," said Sanghavi. "It gives patients and physicians a much more concrete sense of how their interventions are affecting their health."
He also pointed out that the model doesn't reward practices for reducing a single patient's risk but instead looks at the aggregate risk of the practice's entire panel of high-risk Medicare patients. If overall risk is reduced, the practice is rewarded for that.
Sanghavi said family physicians were recruited to be part of this program because, by their very nature, they focus on the whole patient and have an intuitive understanding that no problem occurs in isolation.
The model is part of Million Hearts(millionhearts.hhs.gov), a broad national initiative co-led by CMS and CDC to prevent one million heart attacks and strokes by 2017. Million Hearts brings together communities, health systems, nonprofit organizations, federal agencies and private-sector partners from across the country to fight heart disease and stroke.
Nearly 20,000 health care professionals and more than 3.3 million Medicare fee-for-service beneficiaries (ages 18-79) will participate in the five-year model. The target population is beneficiaries who haven't had a previous heart attack, stroke or transient ischemic attack. Participating patients also cannot be in hospice or have end-stage renal disease.
Practices chosen to participate will be randomized into either an intervention group or a control group.
For those in the intervention arm, the model will offer incentives to calculate CVD risk for all eligible Medicare beneficiaries using the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) 10-year pooled cohort risk calculator and to develop risk-modification plans based on beneficiaries' risk profiles.
Practices assigned to the control group will be asked simply to submit patient clinical data (e.g., age, cholesterol levels, blood pressure readings, etc.) on all of their Medicare patients for CMS to monitor as part of the trial.
After determining each individual's risk for a heart attack or stroke in the next 10 years, practices in the intervention group will then work with patients identified as being at high risk (i.e., those with a more than 30 percent risk for heart attack or stroke during the course of 10 years) to determine the best approach to reduce their individual risk -- for example, stopping smoking, reducing blood pressure, or taking cholesterol-lowering drugs or aspirin. Each high-risk patient will receive a personalized risk-modification plan that targets his or her specific risk factors. Practices will then be paid for reducing the absolute risk for heart disease or stroke among their high-risk patients.
Intervention practices will be paid a one-time $10 per-beneficiary fee to calculate each Medicare patient's ASCVD risk score and to engage patients in shared decision-making. After identifying their high-risk beneficiaries, those practices then will be paid a monthly $10 CVD care management fee for each of those high-risk patients.
Control group practices, meanwhile, will receive a $20 fee for reporting clinical data for all of their Medicare patients during years one, two, three and five of the project.
The Patient Protection and Affordable Care Act created CMS' Innovation Center to test innovative payment and service delivery models, such as the Million Hearts Cardiovascular Disease Risk Reduction Model.
The model is part of the Obama administration's broader strategy to improve the health care system by paying health care professionals for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality, according to the agency's July 21 news release.
In March, the administration announced it had reached its goal, nearly one year ahead of schedule, of tying 30 percent of Medicare payments to alternative payment models that reward the quality of care over the quantity of services provided to beneficiaries.
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