When health care providers enrolled in a payment program that rewarded monitoring and reducing cardiovascular risk in high-risk patients, they focused more on assessing patient risk; they also prescribed cholesterol-lowering and blood pressure-lowering medication more often, according to research presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2020 by Senior Researcher Greg Peterson. The virtual conference, from May 15 to 16, is a premier global exchange among researchers, health care professionals, and policymakers on the latest advances in quality of care and outcomes research in cardiovascular disease and stroke.
“We found that this new payment model made providers more aware of cardiovascular risk among their patients and more focused on ways to work with patients to reduce that risk,” said Peterson, lead author of the study. “Routine risk stratification can prompt meaningful improvements in the use of medications. In particular, the model increased the use of statins for people with elevated cholesterol and increased the use of antihypertensive medications among those with elevated blood pressure. These medications are highly effective in reducing heart attacks and strokes for high-risk patients.”
As part of a broader initiative to prevent one million heart attacks and strokes in the United States over five years, the Centers for Medicare & Medicaid Services launched the Million Hearts® Cardiovascular Disease Risk Reduction Model. The model pays health care providers for measuring each of their Medicare patients’ risk of having a heart attack and stroke over 10 years and for reducing that risk among their high-risk patients.
The model specifically focuses on beneficiaries ages 40 to 79 who have not had a previous heart attack or stroke. As part of a five-year, cluster randomized trial, providers calculated their Medicare patients’ risk of having a heart attack or stroke within 10 years and received incentives to reduce the risk for high-risk patients (those with 30 percent or higher risk of a cardiovascular event at the beginning of the study).
An analysis of the first two years of the program found the following:
- Within six months of enrolling in the program, people identified as high-risk at a Million Hearts® organization were more likely than high-risk people in the comparison group (28 percent versus 24 percent) to initiate or intensify statin therapy or antihypertensive medications.
- Million Hearts® providers indicated that they were nearly twice as likely as the comparison group of providers to assess risk in at least half of their Medicare patients (71 percent versus 39 percent).
Overall, 300,550 Medicare beneficiaries were enrolled in the study across 516 primary and specialty practices, health centers, and hospitals throughout the United States. Half of the organizations were assigned to the intervention group and used the Million Hearts® Model.
Learn more about Mathematica’s research on the Million Hearts® model.