A new Cardiovascular Risk Reduction Model released today by Million Hearts^® proposes a novel way of lowering risks of heart attack and stroke by proposing a new way to pay for prevention.

The model, the first of its kind from the Centers for Medicare and Medicaid Services, will be structured as a randomized trial, made up of Medicare Fee for Service beneficiaries from 360 control and 360 intervention practices, combining for roughly 150,000 subjects in each arm.

Using a data-driven, predictive modelling approach, the Million Hearts model will generate an individualized 10-year risk score for each participant. With access to this information, providers and patients can work together to explore various solutions, such as lowering blood pressure, ending a smoking habit or implementing a statin/aspirin regimen, and then observe the specific positive effects of taking these steps. Practices will be required to re-stratify the patient's risk regularly, and follow it over time.

In terms of payment, the model's value-based payment design will reward statistical reduction in predicted risk of heart attack and stroke, rather than specific blood pressure or cholesterol numbers. Participating doctors will be paid based on the actual reduction of the absolute risk of their entire panel, increasing incentives to manage high-risk patients.

Moving forward, the Risk Calculator is intended as a constant work-in-progress and will be updated as evidence accumulates and expanded as science dictates. Examples include the risk factor vs. longevity paradox in Hispanic patients and increased stroke risk and statin-induced myopathy in Asian Americans.

"As we move towards a system that rewards value over volume, innovative payment model pilots like this are crucial to ensuring we get it right," says ACC President Kim Allan Williams Sr., MD, FACC. "This new initiative has the potential to improve our care of patients in cardiology by moving us in a real way from being "event-driven" toward being "prevent-driven" as a specialty. It is time to turn off the faucet instead of just mopping up the floor."

Practice enrollment is expected to begin in June, with a planned performance start in January 2016 and lasting for five years. For more information, visit the program website or email mhmodel@cms.hhs.gov.

Keywords: Centers for Medicare and Medicaid Services, U.S., Blood Pressure, Cholesterol, Habits, Risk Factors, Myocardial Infarction, Stroke

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