Applauding the Million Hearts Program

Thursday, August 11, 2016 | Larry Sobal

It’s been a busy few months for CMS. Between proposed rules for bundled payments, potentially delaying MACRA, and new initiatives to support primary care,  there has not been a lack of blog content.  So, let’s discuss another recent CMS program, known as the Million Hearts Cardiovascular Disease Risk Reduction Program.

The Million Hearts® model is the latest idea from the CMS Innovation Center (CMMI), which conceptualizes and tests strategies to move the industry from a fee-for-service model to one that pays based on health outcomes. This national initiative has set an ambitious goal to prevent one million heart attacks and strokes by 2017. Million Hearts brings together existing efforts and new programs to improve health across communities and help Americans live longer, healthier, more productive lives. The Centers for Disease Control and Prevention (CDC) and CMMI are the co-leaders of Million Hearts within the U.S. Department of Health and Human Services.

Why is this important? According to the CDC, heart disease is the leading cause of death in the United States. The CDC estimates that heart attacks and strokes result in $300 billion in health care costs each year. Despite the dramatic increases in treatment and reductions in morbidity and mortality, heart disease and strokes still account for one in three deaths in the U.S.

Million Hearts Overview

Million Hearts aims to prevent heart disease and stroke by:

• Improving the quality of care for the appropriate aspirin use, blood pressure control, cholesterol management, smoking cessation (ABCS)
• Reducing the dietary intake of sodium
• Improving the prescription and adherence to appropriate medications for the ABCS 
• Improving access to effective care
• Focusing clinical attention on the prevention of heart attacks and strokes
• Activating the public to lead a heart-healthy lifestyle

I heartily (no pun intended) applaud this first-of-its-kind, nationally randomized trial to use data-driven, predictive modeling for standardizing the assignment of 10-year risk scores across an entire beneficiary population.

Collaboration between Multiple Agencies

Nancy Brown, CEO of the American Heart Association (AHA), noted that “The Million Hearts initiative is unprecedented in its scope and its determination to conquer cardiovascular disease.” In support of the Million Hearts initiative, the CDC’s Division for Heart Disease and Stroke Prevention (DHDSP) awarded the AHA a five-year cooperative agreement to enhance Partner Support for Heart Disease and Stroke Prevention. The award will fund the dissemination of evidence-based cardiovascular disease prevention strategies and resources, promote the use of consistent cardiovascular health messaging, and provide opportunities for sharing of best practices and evidence-based prevention approaches by partners at the state and local level.

Engagement of Physicians and Hospitals

On July 21, CMS publically announced the 516 health care organizations (from more than 750 that applied) in 47 states, Puerto Rico and the District of Columbia, selected to participate in the Million Hearts pilot program. They include practices in general medicine, cardiology, and internal medicine, as well as private practices, community health centers, hospital and physician organizations, and more. Overall, this represents nearly 200,000 health care professionals and more than 3.3 million Medicare beneficiaries.

National Randomized Trial

CMS will randomly assign the 516 organizations to an intervention group or a control group.  Organizations in the intervention group will receive incentives for using the American College of Cardiology/American Heart Association ASCVD 10-year pooled cohort risk calculator and developing risk modification plans. The control group will not be required to implement the ASCVD risk calculator, but will be asked to submit clinical data to compare with the intervention group. The expectation is that the randomized trial will involve roughly 150,000 patients.

Conclusion

Will this work? I’m not sure exactly how the program will quantify the prevention of one million heart attacks and strokes, but I heartily (no pun intended) applaud this first-of-its-kind, nationally randomized trial to use data-driven, predictive modeling for standardizing the assignment of 10-year risk scores across an entire beneficiary population. The shared learning and scientific advancement of the prevention and treatment of heart disease and stroke will be invaluable. This is the type of collaborative and forward-thinking effort that health care needs.

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

 

 

Illustration: Lee Sauer

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