Organizational Efforts to Implement the Million Hearts® Cardiovascular Disease Risk Reduction Model
Authors: Conwell L. 
Published: August 2020

Research Objective

The Million Hearts ® Cardiovascular Disease (CVD) Risk Reduction Model (Million Hearts Model) targets those with the highest 10‐year risk of myocardial infarction or stroke. Organizations assigned to the Model’s intervention group receive financial incentives to assess risk for all eligible Medicare beneficiaries and, for high‐risk beneficiaries (score>30%), to conduct follow‐up contacts and annual reassessment visits to recalculate risk scores. This study assesses how organizations integrated cardiovascular risk stratification and care management into their clinical workflows.

Study Design

Research teams conducted in‐person and/or telephone interviews with administrative staff and frontline providers participating in the Model. Interview data were transcribed, coded, and analyzed to describe how organizations implemented the Model, including any barriers or facilitators encountered.

Population Studied

Organizations (primary care practices, specialty practices, health centers, hospital outpatient departments) throughout the country were randomly assigned to intervention (N=260) or control groups (N=256). We selected a purposive sample of 18 intervention organizations representing a range of geographic locations, practice size, and organizational types. In 2018, we interviewed 15 organizations; in 2019, we interviewed 11 of these organizations plus 3 new ones.

Principal Findings

Despite start‐up challenges, by 2018 the majority of respondents had adapted their workflows to calculate beneficiaries’ cardiovascular risk scores prior to or during a baseline office visit; others calculated risk scores after the visit and followed up with beneficiaries. Electronic health records and care teams facilitated the implementation of the model. Respondents reported risk scores raised providers’ awareness of beneficiaries at high risk of CVD. They reported their existing services could adequately help patients lower their CVD risk. In 2019, organizations continued to calculate risk scores, including for high‐risk beneficiaries due for reassessment visits. Respondents reported increased awareness of risk scores encouraged providers to aggressively and consistently address modifiable risk factors. Respondents perceived that beneficiaries’ awareness of their own risk scores led to improved therapeutic adherence. More than half of the organizations in 2019 reported newly offering additional resources, such as gym memberships, to help patients lower their CVD risk. Although organizations could meet the Model’s clinical requirements, some struggled to meet the Model’s data reporting requirements and dropped out.

Conclusions

Organizations successfully added cardiovascular risk stratification and management processes to their existing workflows, which respondents reported led to systematic calculation and documentation of risk scores. While respondents reported that financial incentives encouraged them to apply for and participate in the Model, most respondents did not view the incentives as large enough to cover their related costs and instead view their efforts as “the right thing to do for patients.”

Implications for Policy or Practice

These findings suggest that the Model is largely being implemented as intended and has increased the extent to which providers calculate CVD risk of their Medicare beneficiaries, identify beneficiaries at high risk, discuss risk scores with them, and treat modifiable CVD risk factors. More specifically, having risk scores available appears to increase providers’ awareness of high‐risk beneficiaries, resulting in opportunities to start or intensify medication therapy to address uncontrolled risk factors.

Primary Funding Source

Centers for Medicare and Medicaid Services.