@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.

Program:

  • 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.

Findings:

  • 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.

Comment:

  • 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.

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