A Novel Medicare Payment Model For Cardiovascular Risk Reduction

In the best of all possible worlds, clinicians would know precisely who would someday go on to have a heart attack or stroke, and be able to intervene well in advance to prevent those outcomes. But for all of the remarkable advances and technology, we still lack a critical tool — a time machine. What if we could transport patients into the future to provide them a sneak peek at their health outcomes, and quality of life? What impact would this have on motivating sustained engagement in critical lifestyle interventions, treatment compliance and medication adherence?

At the Center for Medicare and Medicaid Innovation, a novel model seeks to widely implement the next best thing: the 10-year cardiovascular risk calculator endorsed by the ACC and American Heart Association (AHA). To date, most payment incentives for providers have focused on standardized targets for cholesterol and hypertension control. The model will instead ask providers and patients to focus on how these and more risk factors work together to influence patient’s comprehensive cardiovascular risk. Though not a time machine or crystal ball, this approach does furnish a predictive algorithm that gives providers and patients a glimpse at how their cardiac health will look in the not-too-distant future. Ideally, this view will also encourage helpful preventive actions.

The Million Hearts Cardiovascular Risk Reduction Model is the largest payment model test of a preventive intervention ever performed by the Centers for Medicare & Medicaid Services (CMS) for Medicare fee-for-service beneficiaries. The five-year model incentivizes providers to use the ACC/AHA Atherosclerotic Cardiovascular Disease risk calculator to manage their highest risk patients. It aims to reduce cardiovascular disease risk through patient level risk assessment and shared-decision making. Providers will utilize risk scores to facilitate meaningful conversations that empower patients to take ownership over their health and life. It is the first CMS model to pay for prevention by tying payments to panel-wide 10-year cardiovascular risk reduction. This design specifically encourages clinicians to manage risks across their entire population of patients, and is designed for a randomized evaluation.

CMS looks to trusted members of the clinical community, such as the ACC, to help develop the underlying scientific literature and practices that inform preventive care. As a result, the model closed enrollment in October 2015 with numerous applications and strong interest from providers in all 50 states. The model plans to enroll 300,000 Medicare Fee-For-Service beneficiaries.

CMS looks forward to the model launch in 2016, and to continued strong focus on improving health, lowering costs, and delivering high quality care.

Nina Brown and Darshak Sanghavi, MD are from the Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services in Baltimore, MD.

Sanghavi presented this model during ACC’s Population Health Policy retreat in July.

Keywords: Cardiology Magazine, ACC Publications

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