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Nothing kills more Americans each year than heart disease, but a public-private initiative called Million Hearts is trying to change that.
The effort launched by the Department of Health and Human Services (HHS) and its partners in 2011 seeks to prevent 1 million heart attacks and strokes by 2017, both by increasing awareness about preventative measures and by capitalizing on new payment models under the Affordable Care Act to reward doctors for having healthier patients.
The need for action is clear. About 610,000 people die of heart disease in the United States per year, making it the No. 1 cause of death, according to the Centers for Disease Control and Prevention. Strokes kill another 130,000 people.
But experts say cutting down on such deaths is surprisingly simple under what is known as the ABCS: aspirin for people at risk, blood pressure control, cholesterol management and smoking cessation.
“We largely know what we need to do be doing in [preventing] cardiovascular diseases,” said Jill Birnbaum, vice president at the American Heart Association. “And it’s just a matter of making sure everybody knows that.”
Dr. Janet Wright, executive director of the Million Hearts initiative, said that despite the seeming simplicity of taking aspirin, only about 50 percent of the people who should be taking it are doing so. Likewise, just 50 percent of people with blood pressure problems are working to control them.
“There's an enormous opportunity to improve on some very simple metrics,” Wright said.
Tracking the ABCS is being incorporated into new programs under the Affordable Care Act that seek to reward quality health outcomes rather than the number of health services provided. HHS has a larger goal of tying 30 percent of payments to quality measures by the end of 2016.
The healthcare law created what are known as Accountable Care Organizations, which are groups of doctors that come together to provide coordinated care. The doctors get to keep a share of the money that Medicare saves if they reduce costs and meet health quality targets.
Efforts to prevent heart attacks are now part of the quality targets that these doctors are measured on.
HHS estimates that heart disease and strokes cost $315.4 billion per year, so preventing heart disease can save money.
The Million Hearts effort also includes more traditional education and outreach campaigns. For example, it is signing up congregations to designate one member as a Million Hearts advocate, who gives out information such as blood pressure wallet cards with questions to ask a doctor and tips for keeping blood pressure in check.
Whether the program will meet its goal of preventing 1 million heart attacks and strokes won’t be known until after 2017, but the initiative is already showing signs of progress. There are 4 million fewer cigarette smokers since 2011, and the food services company Aramark has joined with the American Heart Association to pledge to reduce the level of sodium in the 2 billion meals it serves per year.
When HHS announced the Million Hearts effort in 2011, it also put forward $200 million for initiatives such as grants to local health departments for chronic disease prevention and funds for communities to reduce smoking and improve nutrition.
Experts say that, overall, Million Hearts has helped focus the efforts of doctors and advocates.
“What I think Million Hearts really did was to get the cardiovascular health community to begin to focus,” Birnbaum said. The American Heart Association has been convening groups of experts to discuss best practices and develop educational materials.
She added that the Affordable Care Act, in addition to setting in motion the new payment models being used in the initiative, has been key by requiring coverage of preventative health services at no cost to the patient.
“Implementation of the Affordable Care Act has been extremely important,” Birnbaum said. “You’ve got coverage for prevention under private health insurance.”
Wright, of the Million Hearts initiative, says that while “we’re certainly counting” toward the 1 million goal by 2017, the broader goal is to create lasting change.
“Most heart attacks and strokes are preventable, and it's good habits and good care,” she said.
The long-term goal, she said, is to “change the trajectory of heart attack and stroke death for years to come.”