Evaluation of the Million Hearts Cardiovascular Disease Risk Reduction Model: Fourth Annual Report

Evaluation of the Million Hearts Cardiovascular Disease Risk Reduction Model: Fourth Annual Report

Published: Feb 28, 2022
Publisher: Mathematica
Associated Project

Million Hearts Cardiovascular Disease (CVD) Risk-Reduction Model

Time frame: 2017–2023

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services


Rhea Powell

Julia Rollison

Amanda Markovitz

Kate Stewart

Dan Kinber

Rui Wang

Malcolm Williams

Key Findings

The model had the following effects on beneficiaries:

  • Increased the initiation or intensification of statins and anti-hypertensive medications by 3.4 percentage points (31.3 percent in the intervention group and 27.9 percent in the control group) among those who were candidates for treatment.
  • Decreased CVD risk factors—systolic blood pressure and low-density lipoprotein (LDL) cholesterol—by 1.3 percent each, relative to the control group (among the subset of enrollees with the highest CVD risk).
  • Did not measurably reduce first-time heart attacks or strokes.
  • Did not reduce Medicare Part A and B spending.
  • Increased all-cause hospitalizations by 3.8 percent and outpatient emergency department visits by 2.9 percent, relative to the control group.
  • Appears to have reduced all-cause mortality by 0.3 percentage points (with 6.6 percent of people dying within 3 years in the intervention group versus 6.9 percent in the control group).

In 2017, the Centers for Medicare & Medicaid Services (CMS) launched the Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model. In this pay-for-prevention model, CMS pays participating organizations (1) for assessing each of their eligible Medicare fee-for-service (FFS) beneficiary’s risk of having a heart attack or stroke over the next 10 years and (2) for reducing CVD risk among high-risk beneficiaries. The goal of the model is to reduce the incidence of first-time heart attacks and strokes among Medicare FFS beneficiaries and to reduce Medicare spending enough to fully offset model payments. CMS is testing the model in a randomized controlled trial over five years among primary care practices, specialty practices, health centers, and hospital outpatient departments throughout the United States.

Findings at a glance.

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