News | June 05, 2015

New Affordable Care Act Payment Model Seeks to Reduce Cardiovascular Disease

Providers will be reimbursed for reducing individual patients’ risk of heart attack or stroke through personalized plans

June 5, 2015 - Health and Human Services Secretary Sylvia M. Burwell announced an opportunity for healthcare providers to decrease cardiovascular disease risk for Medicare beneficiaries through a new payment model. Using the model, providers can assess an individual patient's risks for heart attack or stroke and work with them to reduce those risks. Secretary Burwell made the announcement at the White House Conference on Aging regional forum in Boston.

Heart attacks and strokes are a leading cause of death and disability. According to the Centers for Disease Control and Prevention, about 610,000 people die of heart disease in the United States every year – accounting for one in every four deaths and costing an estimated $315.4 billion annually. The Million Hearts Cardiovascular Disease (CVD) Risk Reduction model proposes an innovative way of lowering those risks.

Currently, providers are paid to meet specific blood pressure, cholesterol or other targets for their patients as a group. In a new approach, the Million Hearts model will use a data-driven, widely accepted predictive modeling approach to generate personalized risk scores and modification plans for patients.

"The Million Hearts initiative is a part of our efforts to promote better care and smarter practices in our healthcare system," said Secretary Burwell. "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."

Beginning May 28, the Centers for Medicare and Medicaid Services (CMS) is accepting applications for the Million Hearts CVD Risk Reduction model. Healthcare providers who participate in the model will work with Medicare beneficiaries to determine their individual risk for a heart attack or stroke in the next 10 years (for example, 25 percent). Then, providers will work with patients to identify the best approach to reduce their individual risk - for example, stopping smoking, reducing blood pressure, or taking cholesterol-lowering drugs or aspirin - and show them the benefits of each approach. Each patient will get a personalized risk modification plan that will target their specific risk factors. Providers will be paid for reducing the absolute risk for heart disease or stroke among their high-risk patients.

The Million Hearts CVD Risk Reduction model will operate for five years and aims to enroll more than 300,000 Medicare beneficiaries and 720 diverse practices, varying in size and patient case mix; and including providers in general/family practice, general internal medicine, geriatric medicine, multi-specialty care or cardiovascular care.

Million Hearts is a broad national initiative to prevent 1 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.

For more information: www.cms.gov

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