Reducing Cardiovascular Risk in the Medicare Million Hearts Risk Reduction Model: Insights From the National...

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.