Issue link: https://beckershealthcare.uberflip.com/i/717576
85 FINANCE CMO / CARE DELIVERY CMS Reveals New Cardiac, Stroke Innovation Model: 5 Things to Know By Emily Rappleye C MS unveiled the participants ursday of a new innovation model aimed at reducing the risk of heart attacks and strokes, which cause 1 in 3 deaths and result in $300 billion of health- care costs annually. Here are five things to know about the initiative. 1. The new program — dubbed the Million Hearts Cardio- vascular Disease Risk Reduction Model — is a five-year, ran- domized controlled trial. e program's 516 awardees, which include nearly 20,000 providers and more than 3.3 million Medicare fee-for-ser- vice beneficiaries, will be testing a two-step program that firstly assesses individual patients' risk for heart attack or stroke, and secondly provides the necessary prevention interventions for at-risk patients. 2. The initiative is structured as a pay-for-performance pro- gram. Currently, physicians and other clinicians are paid to screen for blood pressure, cholesterol and other measures on an individual, case-by-case basis. is model will be data-driven and use predictive modeling to give each patient a personalized risk score, which physi- cians can then use to create an individual treatment plan for patients. ese interventions may include smoking cessation programs, blood pressure management or cholesterol-lowering drug regimens. Provid- ers are paid based on how much they are able to reduce patients' abso- lute risk scores. 3. Intervention groups are paid a lump sum for every six- month reporting cycle. Payments are made in addition to other services that are provided and billed for, according to CMS. Payment is broken down into two categories: • Providers are given a one-time $10 per-beneficiary payment for each risk assessment they perform on a patient under the program. is is called the Cardiovascular Disease Risk Stratification payment. • Providers are then paid an ongoing monthly sum of $10 for each pa- tient classified as high-risk during the first year of the program. In years 2-5, this payment becomes contingent on performance. Provid- ers are still able to earn up to $10 per-patient per-month based on the percentage improvement to the absolute risk score. e baseline will be static and risk reduction is cumulative. 4. Control groups are paid a one-time $20 payment per beneficiary when they submit data for each reporting pe- riod. ey then continue to provide normal, standard care "in any way they see appropriate for their patients," according to CMS. ey can still provide patients with a cardiovascular disease risk reduction program, but they will not be able to provide specific programming under the Million Hearts Cardiovascular Disease Risk Reduction Model. 5. The model is part of a more broad joint initiative led by CMS and the CDC. e Million Hearts initiative's goal is to prevent 1 million heart attacks and strokes by 2017. n Medicare's Top 20 Costliest Drugs By Brooke Murphy H epatitis C drug Harvoni topped the list of Medicare's priciest prescription drugs in 2015, according to an analysis by the Associ- ated Press, which cites data from CMS' Office of the Actuary. For the list, Medicare's top 20 costliest drugs in 2015 were ranked according to their cost above the pro- gram's catastrophic coverage threshold. Medicare's 2016 catastrophic coverage threshold is $4,850. Af- ter a Medicare beneficiary's out-of-pocket spending reaches this amount, new payment levels for future healthcare costs kick in. The beneficiary pays only 5 percent of costs, the insurer pays 15 percent and tax- payers cover 80 percent. 1. Harvoni (hepatitis C treatment): $6.3 billion 2. Revlimid (cancer): $1.7 billion 3. Sovaldi (hepatitis C): $1.2 billion 4. Copaxone (multiple sclerosis): $1.1 billion 5. Gleevec (cancer): $1 billion 6. Humira Pen (rheumatoid arthritis): $886 million 7. Tecfidera (multiple sclerosis): $724 million 8. Renvela (kidney disease): $675 million 9. Xtandi (prostate cancer): $633 million 10. Lantus Solostar (diabetes): $633 million 11. Zytiga (prostate cancer): $623 million 12. Enbrel SureClick (rheumatoid arthritis): $586 million 13. Abilify (mental illness): $555 million 14. Sensipar (kidney disease): $533 million 15. Truvada (HIV) $525 million 16. Aripiprazole (mental illness): $504 million 17. Lantus (diabetes): $484 million 18. Imbruvica (cancer): $473 million 19. H.P. Acthar (multiple sclerosis): $467 million 20. Lyrica (seizures): $461 million n