By AMERICAN HEART ASSOCIATION NEWS
The Million Hearts CVD Risk Reduction model, part of the Affordable Care Act, gives doctors a new way to tackle heart disease in tens of thousands of Medicare beneficiaries, according to Health and Human Services department Secretary Sylvia Burwell, who made the announcement at the White House Conference on Aging in Boston.
Cardiovascular disease accounts for 17.3 million deaths a year — a number that’s expected to grow to more than 23.6 million by 2030. Its direct and indirect costs are estimated to be $320.1 billion, according to the American Heart Association.
“For whatever reasons, patients and doctors together are not using the most effective treatments and strategies to prevent heart attacks and strokes,” said Darshak Sanghavi, M.D., director of the Prevention and Population Health Models Group at the Center for Medicare and Medicaid Innovation/Centers for Medicare & Medicaid Services at HHS. “We know as a nation we can do much better.”
The answers will come from the data and what healthcare providers and Medicare patients choose to do with it, Sanghavi said. For example, answers input into the computer model could show the patient’s risk of cardiovascular disease and changes that could reduce that risk. The design of the model is randomized, which experts say is the best way to determine if the new payment model helps people.
Sanghavi said such precise heart-healthy predictions are more convincing than a doctor simply telling a patient she should be on blood pressure medication, but leaving questions about the real sense of risk.
“It’s very difficult for you to participate in long-term decisions about your health,” Sanghavi said. “But now we can actually start to see into the future as far as what percentage risks tell us. We can tell patients, ‘if you don’t do anything, this is what’s going to happen.’”
Providers will work with Medicare patients to quit smoking, reduce blood pressure or take aspirin or statins. They’ll be paid for how much they reduce their patients’ absolute risks of heart disease and stroke — a switch from the traditional model where incentives come from meeting targets on things like blood pressure or cholesterol control, without regard to a patient’s preferences and readiness for change.
“This reduces incentives to over treat low-risk patients with medications and interventions they don’t need, but increases incentives to work harder with high-risk patients,” Sanghavi said.
Vincent Bufalino, M.D., a cardiologist at Advocate Medical Group in Naperville, Illinois, and an AHA volunteer, said this approach will spell out the risks for those who have a nagging suspicion that they should lower their cholesterol or increase their exercise, but haven’t done anything about it.
“Most people don’t see themselves as high risk. It doesn’t compute that they’re a candidate for a heart attack,” Bufalino said. “It’s nothing complex or deep. If you can get these things in compliance, you will change your risk and lower your risk of having a heart attack or a stroke.”
That includes the younger crowd, which also should be paying attention to heart health.
“We have lots of people having heart attacks in their 30s or 40s,” Bufalino said. “We want to be able to call out folks and say, ‘yes, you should get an intervention. You owe it to your family to take care of yourself so you’ll be around to take care of them.’”