Put pharmacists in the game: Apply for the Million Hearts CVD Risk Reduction model

Pharmacists are no strangers to providing team-based care to prevent cardiovascular disease. For months, I have been stressing the importance of pharmacists being on the team and getting in the game. Here is a remarkable chance for pharmacists to show up, serve, and demonstrate our value!

U.S. Department of Health & Human Services Secretary Sylvia M. Burwell just announced a unique opportunity for health care providers to decrease cardiovascular disease risk for tens of thousands of Medicare beneficiaries by assessing an individual patient’s risk for heart attack or stroke, and working with them to reduce those risks.

The Million Hearts Cardiovascular Disease (CVD) Risk Reduction model seeks to bridge a gap in cardiovascular care by providing targeted incentives for providers to engage in individual CVD risk calculation and population-level risk management. This is all part of the “better care, smarter spending, healthier people” approach highlighted by Burwell earlier this year.

CMS has announced a Request for Applications for the Million Hearts CVD Risk Reduction model. APhA is currently reviewing the details of the Request for Applications. We will post more information about how to encourage participating physician practices to include pharmacists in their team-based approach to preventing cardiovascular disease. Here is the direct link to the Request for Applications: http://innovation.cms.gov/initiatives/Million-Hearts-CVDRRM/.

Approximately 720 practices will be selected from the pool of eligible applicants and divided into an intervention group and a control group. Eligible practices will need at least one health care provider, defined as medical doctors, doctors of osteopathic medicine, physician assistants, and nurse practitioners. Practices must use an Office of the National Coordinator for Health Information Technology certified electronic health record (EHR) system. Participating physician providers or professionals within the practice must have met the criteria for the Medicare EHR Incentive Programs Stage 1, also known as “meaningful use,” of an Office of the National Coordinator certified EHR.

The randomized controlled trial design will require practices to participate in risk-stratified care; population health management; shared decision making; patient care planning; quality and clinical data reporting; and, perhaps most importantly for pharmacists, team-based care.

I believe that physician practices that choose to participate in this model have a better chance of success if they include a pharmacist on their team. I hope these practices follow the lead of the many practices participating in the CMS Center for Medicare & Medicaid Innovation Comprehensive Primary Care medical home that spent a portion of their enhanced care coordination payments on team-based care. 

A number of studies have documented the value of pharmacists in managing high blood pressure, cholesterol, and diabetes. The Health & Human Services Community Preventive Services Task Force has found strong evidence that team-based care can improve blood pressure control when a pharmacist is included on the team. The Asheville Project demonstrated a marked improvement in the health of patients with diabetes, asthma, lipid management, hypertension, and depression when pharmacists were involved with their care.

In 2013, CDC published a resource guide to help pharmacists develop collaborative practice agreements and sustainable business models that support this type of team-based care.

The risk stratification described in the new Million Hearts CVD Risk Reduction model can help identify Medicare beneficiaries who can benefit most from pharmacist services as a component of population health management and care planning. And because quality measure reporting is also required, this could be an excellent opportunity to demonstrate the value of pharmacists in improving, reporting, and maintaining key population health metrics.

More information about the Million Hearts CVD Risk Reduction model can be found at http://millionhearts.hhs.gov/index.html.