Abstract 271: Variation in Practice Characteristics and Geographic Uptake of Novel Centers for Medicare and Medicaid Services Payment Model for CV Risk Reduction

Background: The Million Hearts® Cardiovascular Disease risk reduction model was developed to reduce CVD risk through patient level risk assessment and shared-decision making. Budgeted for $63 million (CMMI + Trust fund dollars should be included), it is the first CMS model to pay for prevention by tying payments to panel-wide 10-year risk eduction. The Model’s simple design does not require large operational or organizational changes and might appeal to a wider range of practices that have not previously enrolled in CMMI models. Model Design & Payment: The 5-year Model incentivizes providers to use the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator to manage their highest risk patients. To test the efficacy of the model, half of all practices will be randomly assigned to the intervention group with the remaining practices assigned to the control group. For intervention practices, a monthly performance payment of up to $10 per beneficiary is provided based upon the total risk reduction. Practice enrollment was encouraged via partnership with major professional societies, social media, peer-reviewed publications, and direct outreach. Discussion on Model and Participating Physician Group Practices: The model attracted a broad range of 462 physician practices from all 50 states, including a high percentage of rural (35.3% 163 of 462), primary care/specialty clinics (48.9% 226 of 462) and community health centers (13.0% 60 of 462). The applicant pool represents 3,451 service delivery sites, employing 21,696 providers, delivering care to 4,864,390 Medicare beneficiaries. Over one half practices are small (39.8% 176 of 462, 5 or fewer providers) and medium (14.3% 66 of 462, 6-10 providers) in size. It is likely the model’s administrative simplicity drove large numbers of smaller practices that operate outside large health systems to apply. In addition, for the majority of practices that applied (42.2% 195 of 462), this is the first CMS model they participate in - another indication that the Model has attracted new practice types and sizes than other CMS Innovation models.