Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

CMS Selects 516 Orgs for Population Health Management Program

CMS has added 516 participants to its population health management initiative designed to reduce the risk of cardiovascular disease among Medicare beneficiaries.

By Jacqueline LaPointe

- According to a recent announcement, CMS has selected 516 participants to join the Million Hearts Cardiovascular Disease Risk Reduction Model, a five-year population health management initiative designed to prevent heart attacks and strokes among Medicare fee-for-service beneficiaries.

CMS selects 516 participants to join population health management model

“Our healthcare system historically often emphasized acute care over preventive care,” said Patrick Conway, MD, CMS Acting Principal Deputy Administrator and Chief Medical Officer. “This initiative will enhance patient-centered care and give practitioners the resources to invest the time and in staff to address and manage patients who are at high risk for heart attacks and strokes.”

Cardiovascular disease is not only a significant contributor to disability, but it is also the leading cause of death in the country, reported the Centers for Disease Control. With one in three deaths caused by heart attacks and strokes, these events cost the healthcare industry up to $300 billion each year.

Using the Million Hearts Cardiovascular Disease Risk Reduction Model, CMS aims to redesign how providers are reimbursed for preventative services to encourage more screenings for blood pressure, cholesterol, and other risk factors.

The population health initiative employs a data-driven predictive analytics approach to produce risk scores for each patient and create personalized treatment plans to decrease the score.

To generate risk scores, providers will use the American College of Cardiology/American Heart Association’s 10-year Atherosclerotic Cardiovascular Disease pooled cohort risk calculator. The calculator uses patient data, such as age, blood pressure, cholesterol level, and gender, to determine their 10-year risk of developing cardiovascular disease.

Healthcare providers in the intervention group of the model will be required to partner with beneficiaries to develop a personalized care plan for reducing specific risks associated with heart attack and stroke. For example, some beneficiaries might participate in smoking cessation interventions, blood pressure management initiatives, or cholesterol-lowering drug regimes.

Providers will also have to explain the benefits of each approach to beneficiaries.

The healthcare organizations in the intervention group will be reimbursed for reducing the composite risk scores among their high-risk beneficiaries, who have a risk score of 30 percent or more. They will receive a monthly Cardiovascular Care Management payment per Medicare beneficiary.

For those in the control group, providers will only report clinical data, such as age and cholesterol level, for eligible beneficiaries.

CMS expects the population health management model to involve 20,000 healthcare providers and cover 3.3 million Medicare fee-for-service beneficiaries over the five-year period, which starts in September.

The model also supports the Million Hearts organization’s goal of preventing one million heart attacks and strokes by 2017 through partnerships among communities, healthcare systems, non-profit organizations, federal agencies, and private-sector entitie


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