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. Under this model, CMS paid participating health care organizations to measure and reduce CVD risk, and organizations committed to following guideline-recommended care processes for the primary prevention of CVD. The model's goal was to reduce the incidence of heart attacks and strokes, including transient ischemic attacks (mini strokes), among Medicare beneficiaries ages 40 to 79 who had not previously had one. CMS hoped reduced spending on heart attacks and strokes would offset the model payments, making the Million Hearts Model cost-neutral to Medicare. CMS tested the model from 2017 to 2021 in a large, randomized trial, including hundreds of thousands of beneficiaries across the United States. Over five years, the Million Hearts Model reduced the incidence of first-time heart attacks and strokes by 3 to 4 percent among beneficiaries at high or medium risk of these events but did not measurably affect Medicare spending. The reduction in heart attacks and strokes corresponds (depending on the outcome definition used) to roughly one prevented event over five years for every 250 to 400 high- and medium-risk beneficiaries enrolled. The evaluation did not detect savings in Medicare spending for the events. However, model payments were small, at an estimated $1 per month of enrollment per high- and medium-risk beneficiary in the evaluation population. As a result, total Medicare spending, including Parts A and B and model payments, was similar between intervention and control group beneficiaries. These findings for the study's primary outcome measures reflect the accumulation of changes along a hypothesized causal pathway (Figure ES.1). The reduction in first-time heart attacks and strokes was accompanied by a 4 percent reduction in all-cause mortality over five years among high- and medium-risk beneficiaries. Consistent with the model logic, the largest relative declines, by cause, were among deaths due to coronary heart disease (CHD) and cerebrovascular disease.