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Reducing Cardiovascular Risk in the Medicare Million Hearts Risk Reduction Model: Insights From the National
William B Borden1, Jingyan Wang2, Philip Jones3
1George Washington University, Washington, DC (W.B.B.).
Insights
The Million Hearts initiative can significantly reduce atherosclerotic cardiovascular disease (ASCVD) risk in high-risk Medicare patients. Achieving optimal risk factor reductions in cardiology practices could lead to substantial ASCVD risk reduction and incentive payments.
Area of Science:
- Cardiology
- Public Health
- Health Economics
Background:
- The Million Hearts Cardiovascular Disease Risk Reduction Model incentivizes practices to reduce 10-year atherosclerotic cardiovascular disease (ASCVD) risk in high-risk Medicare patients (ASCVD risk ≥30%).
- This study estimates average practice-level ASCVD risk reduction by applying optimal clinical trial outcomes to a real-world, high-risk population.
Purpose of the Study:
- To estimate the potential average practice-level ASCVD risk reduction achievable within the Million Hearts Model.
- To assess the proportion of practices that could meet incentive thresholds based on modeled risk factor modifications.
Main Methods:
- Utilized observational registry data from the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PICE) Registry (January 2013–June 2016).
- Modeled ASCVD risk reductions using historical clinical trial data for cholesterol (26.5%), systolic blood pressure (10.9%), and smoking cessation (21.8%).
- Calculated average ASCVD risk reduction from individual and combined risk factor modifications and determined the percentage of practices achieving Million Hearts incentive thresholds.
Main Results:
- The study population included 135,166 patients, with 16,248 (12.0%) identified as high-risk (10-year ASCVD risk ≥30%) without existing ASCVD.
- Mean 10-year ASCVD risk in the high-risk group was 41.9%.
- Combined risk factor reductions (cholesterol, blood pressure, smoking) modeled a 9.7% ± 3.6 reduction in 10-year ASCVD risk. 73.0% of practices achieved ≥10% risk reduction, and 27.0% achieved 2-10% reduction.
Conclusions:
- Approximately 1 in 8 patients in cardiology practices have high ASCVD risk (≥30%) qualifying for the Million Hearts Model.
- Targeting key modifiable risk factors and achieving clinical trial-like reductions can substantially lower ASCVD risk.
- The Million Hearts Model demonstrates significant potential benefits, and these findings offer guidance for participating practices to achieve incentive payments.
Background:
The Million Hearts Cardiovascular Disease Risk Reduction Model provides financial incentives for practices to lower 10-year atherosclerotic cardiovascular disease (ASCVD) risk for high-risk (ASCVD ≥30%) Medicare patients. To estimate average practice-level ASCVD risk reduction, we applied optimal trial outcomes to a real-world population with high ASCVD risk.
Methods:
This study uses observational registry data from the National Cardiovascular Data Registry Practice Innovation and Clinical Excellence Registry from January 2013 to June 2016. We modeled ASCVD risk reductions using historical clinical trial data (reducing cholesterol by 26.5%, reducing systolic blood pressure by 10.9%, reducing smoking rates by 21.8%) the average reduction in ASCVD risk associated with individual and combined risk factor modifications, and then percentage of practices achieving the various incentive thresholds for the Million Hearts Model.
Results:
The final study population included 135 166 patients, with 16 248 (12.0%) with 10-year ASCVD risk of ≥30%, but without existing ASCVD. The mean 10-year ASCVD risk was 41.9% (±1 SD of 11.6). Using risk factor reductions from clinical trials, lowering cholesterol, blood pressure, and smoking rates reduced 10-year ASCVD risk by 3.3% (±3.1), 6.3% (±1.1) and 0.5% (±1.3), respectively. Combining all 3 reductions resulted in a 9.7% (±3.6) reduction, with 67 (27.0%) of practices achieving a patient-level average 10-year ASCVD risk reduction of ≥10%, 181 (73.0%) achieving a 2 to 10% reduction, and no practice achieving <2% reduction.
Conclusions:
In cardiology practices, about 1 out of 8 patients have a 10-year ASCVD risk ≥30% and qualify as high risk in the Million Hearts Model. If practices target the three main modifiable risk factors and achieve reductions similar to clinical trial results, ASCVD risk could be substantially lowered and all practices could receive incentive payments. These findings support the potential benefit of the Million Hearts Model and provide guidance to participating practices.
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