Evaluation of the Million Hearts® Cardiovascular Disease Risk Reduction Model

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.

Over four years (2017 to 2020), the model has improved CVD preventive care, including risk assessment, but has not measurably reduced first-time heart attacks or strokes or reduced Medicare spending. The model has increased all-cause hospitalizations and outpatient emergency department visits and appears to have modestly reduced all-cause mortality rates. Although the COVID-19 pandemic has created several challenges to implementing the model, and organizations have adapted their implementation strategies accordingly, the main findings are largely consistent with those we reported earlier covering the model's first three years (Blue et al. 2020).