@CMSGov reported RCT results for Million Hearts - a national HHS pay-for-performance model to prevent heart attacks & strokes in Medicare patients. Quick take: No impact on first-time heart attacks/strokes or Medicare spending over 3-4 years, but follow-up is ongoing.


  • Launched in 2017, the HHS/CMS Million HeartsĀ® Model pays healthcare providers to (i) use a novel risk assessment tool to identify fee-for-service Medicare patients at risk of heart attack or stroke, & (ii) provide these patients with cardiovascular care management services.

Study Design:

  • The study randomly assigned 516 organizations (primary care & specialty practices, health centers, & hospital outpatient departments) to a treatment group vs a usual-care control group. These organizations enrolled a patient sample of about 219,000 over two years.


  • On the primary long-term outcomes measured over 3-4 yrs: (i) No impact on rate of first-time heart attack, stroke, or TIA (mini-stroke) in high-risk patients (5.2% T vs 5.4% C); (ii) no reduction in Medicare spending in high & medium risk patients ($922/patient/month T vs $918 C).

  • The study claims to have found a small decrease in all-cause mortality & increase in all-cause hospitalizations & ED visits, but these were post-hoc exploratory outcomes that are not reliable under established scientific standards (FDA, IES), as they could easily be due to chance.


  • Based on careful review, this was a mostly well-conducted RCT (e.g., modest, non-differential attrition among the organizations, excellent baseline equivalence among organizations and patients). Study follow-up will continue for 1 more year.

We use cookies to improve your experience and to help us understand how you use our site. Please refer to our cookie notice and privacy statement for more information regarding cookies and other third-party tracking that may be enabled.

Intuit Mailchimp logo