CMS unveiled the participants Thursday of a new innovation model aimed at reducing the risk of heart attacks and strokes, which cause 1 in 3 deaths and result in $300 billion of healthcare costs annually.
Here are five things to know about the initiative.
1. The new program — dubbed the Million Hearts Cardiovascular Disease Risk Reduction Model — is a five-year, randomized controlled trial. The program's 516 awardees, which include nearly 20,000 providers and more than 3.3 million Medicare fee-for-service beneficiaries, will be testing a two-step program that firstly assesses individual patients' risk for heart attack or stroke, and secondly provides the necessary prevention interventions for at-risk patients.
2. The initiative is structured as a pay-for-performance program. Currently, physicians and other clinicians are paid to screen for blood pressure, cholesterol and other measures on an individual, case-by-case basis. This model will be data-driven and use predictive modeling to give each patient a personalized risk score, which physicians can then use to create an individual treatment plan for patients. These interventions may include smoking cessation programs, blood pressure management or cholesterol-lowering drug regimens. Providers are paid based on how much they are able to reduce patients' absolute risk scores.
3. Intervention groups are paid a lump sum for every six-month reporting cycle. Payments are made in addition to other services that are provided and billed for, according to CMS. Payment is broken down into two categories:
- Providers are given a one-time $10 per-beneficiary payment for each risk assessment they perform on a patient under the program. This is called the Cardiovascular Disease Risk Stratification payment.
- Providers are then paid an ongoing monthly sum of $10 for each patient classified as high-risk during the first year of the program. In years 2-5, this payment becomes contingent on performance. Providers are still able to earn up to $10 per-patient per-month based on the percentage improvement to the absolute risk score. The baseline will be static and risk reduction is cumulative.
4. Control groups are paid a one-time $20 payment per beneficiary when they submit data for each reporting period. They then continue to provide normal, standard care "in any way they see appropriate for their patients," according to CMS. They can still provide patients with a cardiovascular disease risk reduction program, but they will not be able to provide specific programming under the Million Hearts Cardiovascular Disease Risk Reduction Model.
5. The model is part of a more broad joint initiative led by CMS and the CDC. The Million Hearts initiative's goal is to prevent 1 million heart attacks and strokes by 2017.
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