
In a recent study published in JAMA, researchers investigated whether the Million Hearts payment model reduced the incidence of cardiovascular events (CVS), including strokes, myocardial infarctions (MIs), and Medicare expenditure amongst Medicare beneficiaries.
Study: Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending: A Randomized Clinical Trial. Image Credit: chayanuphol / Shutterstock.com
Background
Cardiovascular diseases (CVDs) remain a number one reason behind mortality across the globe, thus warranting the event of strategies to discover associated risk aspects and interventions for risk modification to enhance cardiovascular health.
The Million Hearts payment model incentivized healthcare organizations to guage and reduce CVD risk. Nonetheless, the long-term impacts of the model on CVD outcomes remain unknown.
Between 2017 and 2021, the Centers for Medicare and Medicaid Services (CMS) provided intervention organizations with one-time payments of $10 for every beneficiary for whom risk was evaluated. In 2017, CMS only paid intervention organizations $10 for every high-risk beneficiary monthly to help cardiovascular care provision.
Subsequently, between 2018 and 2021, CMS made performance-based risk-reduction payments. To this end, CMS paid the organizations for high-risk beneficiaries to be re-evaluated annually based on their mean risk rating changes every month.
In regards to the study
The present trial was conducted between January 3, 2017, and December 31, 2021. A complete of 342 United States-based healthcare organizations, including primary care, specialty practices, hospital outpatient care clinics, and health centers, were included within the study, which comprised 218,864 individuals.
The organizations were assigned to either the intervention group of beneficiaries (172 organizations, 130,578 individuals) or the control group of people receiving regular care (170 organizations, 88,286 individuals).
The sample population included Medicare recipients between 40 and 79 years of age without prior stroke or MI history and with medium-high cardiovascular risk. The intervention group organizations performed guideline-based care, including regular cardiovascular risk evaluation and care provision for high-risk individuals.
CMS paid the organizations to find out cardiovascular risk evaluation scores for the beneficiaries and rewarded health organizations for decreasing CVD risk for high-risk Medicare recipients with cardiovascular risk scores of 30% or higher.
Study outcomes included incident CVS akin to transient ischemia, MIs, and strokes documented within the Medicare claims, incident cardiovascular outcomes in claims, and cardiovascular mortality from cerebrovascular disease or coronary artery disease, as indicated within the National Mortality Index data, and Parts A in addition to B of Medicare expenditure for CVS. Cox proportional hazard modeling was performed to calculate the hazard ratios (HRs).
CVD risk scores were based on demographic data akin to race, age, and gender, clinical parameters akin to diabetes status, lipid levels, blood pressure, antihypertensive medications, and smoking status. Cardiovascular care services provided to high-risk beneficiaries included cardiovascular risk discussion, developing risk reduction strategies tailored to individuals, in-person re-evaluation visits annually, including recalculating 10-year cardiovascular risk scores using calculators, and extra contact two or more times annually to evaluate progress.
Study findings
The intervention and control group beneficiaries had comparable age medians of about 72 years, sex distributions of 58% and 59% men and women, respectively, race demographics, and initial cardiovascular risk scores with a median value of 24%. After a median follow-up of 4.3 years, 7.8% and eight.1% of the intervention and control group beneficiaries were diagnosed with incident cardiovascular diseases, respectively.
The likelihood of an incident CVS inside five years was 0.30% less for the intervention group beneficiaries than the control. The five-year likelihood of combined incident CVS and related mortality was 0.40% lower amongst intervention group beneficiaries.
The model intervention group beneficiaries were related to a 4.3% lower mortality rate, with a notable 14% lower mortality from coronary artery disease amongst those with high CVD risk in comparison with the control group. Nonetheless, Medicare expenditure for CVS was comparable between the study groups, with effect estimates of a $1.80 reduction for every beneficiary every month.
Likewise, overall Medicare expenditure, including the Million Hearts model payments, was related to an effect estimate of $2.10 for every beneficiary every month. Similar findings were obtained within the sensitivity analyses based on end result definitions, population compositions, and regression specifications.
Conclusions
The Million Hearts payment model reduced the chance of new-onset MIs and strokes amongst medium-to-high-risk individuals by 0.3 percentage points over five years without significant changes in Medicare spending. These findings suggest that paying for cardiovascular risk evaluation and reduction could improve cardiovascular outcomes within the U.S.
Nevertheless, further research is required to enhance the generalizability of the study findings, because the pragmatic cluster-randomized trial may introduce potential biases and limit the study’s accuracy. Long-term effects on healthcare costs may emerge over time.
Journal reference:
- Blue, L., Kranker, K., Markovitz, A. R., et al. (2023). Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending: A Randomized Clinical Trial. JAMA 330(15);1437-1447. doi:10.1001/jama.2023.19597