Million Hearts: Cardiovascular Disease Risk Reduction Model - Frequently Asked Questions

 

General Questions

1) What is the Million Hearts® Cardiovascular Disease Risk Reduction Model?

The Million Hearts®: Cardiovascular Disease Risk Reduction Model is an opportunity for healthcare professionals to design sustainable models of care to decrease cardiovascular disease risk for tens of thousands of CMS beneficiaries. This will contribute to the Administration’s “better care, smarter spending, healthier people” approach to improving the health care delivery system.

Through this model, health care providers will work with Medicare beneficiaries to calculate their individual risk for a heart attack or stroke in the next 10 years (for example, 25 percent), based on their comprehensive profile of age, risk factors, blood tests, and behavioral factors. Then, providers will work with patients to explore the various approaches for reducing the risk of heart attack or stroke—for example, stopping smoking, reducing blood pressure, or taking statins or aspirin—and show them the specific effects and benefits of each approach. Providers will be paid for how much they reduce absolute risk across their entire panel of high-risk patients.

 

2) What authority does CMS have to release this solicitation?

Section 1115A of the Social Security Act (added by section 3021 of the Affordable Care Act) authorizes the Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) expenditures while maintaining or enhancing the quality of beneficiaries’ care.

 

3) What types of organizations are eligible to apply for this model test?

Eligible organizations include a diverse range of clinical practices —varying in size, patient case mix, and other patient demographic factors. An example of the types of practices are eligible to apply to participate in the Million Hearts® CVD Model include but are not limited to:

  • General/family practice, internal medicine, geriatric medicine, multi-specialty care, or cardiovascular care. 
  • Applicants can be private practice owners, community health centers and other community-based clinics, hospital-owned physician practices, hospital/physician organizations, or retail clinics.

 

4) What are the eligibility requirements that practices must meet in order to apply for this model test?

The eligible requirements for a practice and organization to be selected for this Model test  include:

  • Practices must have at least 1 practitioner. Practitioners are defined as Medical Doctors, Doctors of Osteopathic Medicine, Physician Assistants, and Nurse Practitioners.
  • Practitioners are required to be enrolled  in and eligible to bill for Medicare part B.
  • Practices must be using an Office of the National Coordinator for Health Information Technology (ONC) certified Electronic Health Record system.
  • Participating physician or other eligible professionals within the practice must have met the criteria for the Medicare EHR Incentive Programs in performance year 2014, also known as “meaningful use,” of an Office of the National Coordinator certified electronic health record.

 

5) What are eligibility criteria for beneficiaries in the model test?

The target population of beneficiaries must meet the following criteria:

  • The target population for the Million Hearts® CVD Model is all Medicare FFS beneficiaries aged 18-79 years of age.

 

6) How many applicant practices will be awarded for this model test?

Approximately 720 applicants will be selected for entry into the model test (360 intervention group practices and 360 control group practices).

 

7) When is the Letter of Intent (LOI) due? Is an applicant required to apply for the model if it submits a LOI?

Interested applicants must submit a non-binding letter of intent (LOI) no later than September 10, 2015. Letters of intent will be used for planning purposes only and the LOI will not be binding. Applicants will not be allowed to submit an application without first submitting a LOI.

 

8) When are applications due? How long is the application period open?

Applications are due no later than September 10, 2015. The application period is open for 60 days.

 

9) How will applications be reviewed and selected?

Applications will be submitted through the electronic system. Eligible applicants will be selected on a first come, first serve basis. CMS reserves the right to also select practices based on geographic coverage and diversity.

 

10) How will applicants be chosen to be part of the control group?

Once a pool of practices has been selected to participate in the model, applicants will enter into Model Participant Agreements (MPAs) with CMS. At that time applicants will be randomized at a ratio of 1:1 to the intervention or control group.

 

11) What is the duration of this model test?

This model will be tested over a 5-year period. The model will begin January 2016 and end by December 2020.

 

12) What is the payment model for this initiative?

The payment Model is a “pay-for-outcomes” approach that rewards achievement and cardiovascular disease risk reduction. The Million Hearts® CVD model will provide 2 types of payments for intervention group practices:

  • Cardiovascular Disease Risk Assessment (CVD RA) payment - The CVD RA Payment is a onetime payment to risk stratify eligible beneficiaries using the American College of Cardiology/ American Heart Association/ (ACC/AHA) Atherosclerotic Cardiovascular Disease (ASCVD) Pooled Cohort 10 year risk calculator.
  • Cardiovascular Care Management (CVD CM) payment - The CVD CM payment is a monthly payment to support the management, monitoring, and care of beneficiaries identified as high-risk based on the initial risk stratification.

 

13) What are the allowable uses of the monthly incentive payments?

The $10.00 CVD CM payment can also be used by each intervention group practice to cover the costs of implementing the model as they see fit, including material, equipment, or staffing costs.

 

14) What is the process of beneficiary attribution? How frequently will this occur?

The process for identifying and validating eligible beneficiaries is outlined below:

  1. CMS will acquire the following information about the practice from the practice’s application:
    • Legal Business Name, Tax Identification Number, and  Type 2 NPI, and HCCN if applicable;
    • Type 1 NPI of participating clinicians;
  2. CMS will review 2 years of claims for billing organization EIN/Type 2 NPI combinations to identify beneficiaries who meet the eligibility criteria.
  3. Beneficiaries will be attributed to the EIN of the health care organization that billed for the plurality of Evaluation and Management (E & M) charges during the most recent 12-month period.  If a beneficiary has an equal number of qualifying visits to more than one practice, the beneficiary will be attributed to the practice with the most recent visit.

Beneficiary attribution will occur at the beginning of each performance year throughout the model test for the purposes of updating beneficiary attribution lists with exclusion criteria.

Additional information can be found via the Million Hearts CardioVascular Disease Risk Reduction Model web page.

 

15) What does a practice do for patients they are assigned to the intervention group?

Practices would have their choice of 2 options. First, they could use a free web-based tool to be provided by CMS, which will allow them to enter and calculate a patient’s 10-year CVD risk, and follow that risk over time. The tool will also have built in decision support, a performance dashboard, and patient education tools, to help providers manage their patient panel. The tool will automatically report this information to CMS, and trigger payments to the provider. Or, second, practices could choose to develop or use their own tools, which can interface ultimately with CMS to report performance and trigger payments.

 

16) What does a practice do for patients if they are assigned to the control group?

They continue to provide care in their usual manner. No change in direct patient care would be requested by CMS. The practice would be paid to have administrative staff enter and report clinical information on Medicare FFS beneficiaries regularly, for purposes of developing the control group.

 

17) Is there additional information on the selection process that can be provided?

Practices will be selected on a first come first serve basis until we have reached 720. There will be basic completeness checks and CMS reserves the right to select practices based on geographic need should more than 720 practices apply. Once practices are selected, they will be randomized into the treatment or the control group.

 

18) If bullet one is confirmed I will then receive many questions about what the significance of the Application Questions are. If these will not be used as part of selection what role do they play? If a practice is selected to participate, and ends up in the Intervention Group, will the practice be expected to implement what they documented for these questions?

Yes, practices will be expected to implement what they documented for the questions. They will be required to submit data twice a year as well as completion of a twice a year survey that will assess how well they have implemented what they proposed to allow CMS to monitor performance and implementation of the program.

 

ACC/AHA CVD Risk Calculator

1) Is my practice expected to calculate patient risk scores using the online tool and record that information in the Electronic Health Record?

Correct. Practices can use whatever version of the tool works best with their work flows. This could be online, the downloadable excel spreadsheet, i-Phone app, etc. The expectation is that this risk scores will be captured in the EHR so that it can be reported to CMS every 6 months.

 

Reporting

1) Will the data elements need to be submitted in a file generated by the EHR?

CMS is still in the process of finalizing the data collection platform for the model. It is anticipated that the data collection platform will accept data in multiple formats, i.e. file generated by EHR, manual entry, etc.

 

Payment

1) How much will practices be paid for their participation for this model?

Each intervention group practice will receive a onetime CVD RA payment of $10.00 per beneficiary to conduct the initial risk stratification. A CVD CM payment of $10.00 per beneficiary per month (PBPM) will be available to each practice to support efforts to achieve and maintain Cardiovascular Risk Reduction in the highest risk patients.

Assume a three provider practice is enrolled in the model. The practice provides services to a panel of 500 Medicare beneficiaries that meet the definition of the target population. The practice conducts the risk stratification and identifies 50 beneficiaries as being high risk by the end of June. This practice has the potential to receive $8,000 in year one of the model. In years 2-5, the practice has the potential to earn a maximum of $6,000 each year if meeting the conditions to receive the full $10 monthly CVD CM payment. Over the life of the model, a practice could earn $32,000 for their cardiovascular disease reduction work. Please refer to the RFA or separate website attachment for the full incentive schedule.

Each control group practice will receive a one-time upfront payment of $20.00 per beneficiary in the target population for each successful submission of data. This payment can be used to cover the administrative cost of accessing and providing the data. This includes materials and staffing costs. Assume a one provider solo practice is randomized to the control group. The practice provides services to a panel of 300 Medicare beneficiaries that meet the definition of the target population. This practice will be compensated $6,000 for each reporting year upon the completion of successful reporting.

 

2) Will payments remain the same throughout the duration of the model?

No. During the first year, intervention group practices will receive a $10.00 PBPM, the full CVD CM payment. In subsequent years, a percentage of the payment will gradually be placed “at risk” – meaning that the intervention group practices will progressively earn the full CVD CM payment only by meeting aggregate absolute 10-year Atherosclerotic Cardiovascular Disease Risk Reduction benchmarks. Please refer to the RFA for the full incentive schedule.

 

3) For the CVD CM payment how was the incentive structure developed?

The incentive structure was developed in such a way to drive practices to achieve outcomes. CMS modeled different scenarios to assess a reasonable risk reduction that’s achievable among high risk individuals while still providing meaningful incentives to providers.

 

4) Are the CVD CM payments lump sum payments made every six months?

Yes

 

Treatment Benefit Equation

1) Can you provide more information on the ‘ASCVD treatment-benefit tool to measure longitudinal performance in absolute risk reduction’ is? Is this something that exists today? If not, will it be developed and provided to participating practices? Or is this being used in a general sense and the expectation is the practices will develop a tool to allow them to measure longitudinal performance?

This tool is currently in development. Once developed, the tool will be provided to practices free of charge and CMS will provide training and technical assistance on how the tool is used.