Table 2. Baseline Characteristics of Medicare Beneficiaries Entering the Model in 2017 or 2018.
| Characteristic | No. (%) | |||
|---|---|---|---|---|
| High-risk beneficiaries | Medium-risk beneficiaries | |||
| Intervention (n = 40 423) | Control (n = 27 277) | Intervention (n = 90 155) | Control (n = 61 009) | |
| Demographics and socioeconomic status | ||||
| Age, median (IQR), ya | 75 (71-77) | 75 (71-77) | 71 (68-74) | 71 (68-75) |
| Black raceb | 3103 (8) | 1753 (6) | 7373 (8) | 4047 (7) |
| Mena | 26 434 (65) | 17 833 (65) | 49 202 (55) | 34 176 (56) |
| Women | 13 989 (35) | 9444 (35) | 40 953 (45) | 26 833 (44) |
| Dually eligible for Medicaida | 3788 (9) | 2746 (10) | 8675 (10) | 6093 (10) |
| Risk factors for myocardial infarction and stroke | ||||
| CVD risk score, median (IQR), percentage pointsc,d | 37 (33-45) | 38 (33-45) | 21 (18-25) | 21 (18-25) |
| Diabetes | 25 828 (64) | 17 033 (62) | 24 516 (27) | 16 813 (28) |
| Ischemic heart diseasee | 15 403 (38) | 10 728 (39) | 26 454 (29) | 19 076 (31) |
| Total cholesterol, median (IQR), mg/dLc | 164 (140-193) | 164 (139-194) | 173 (148-201) | 172 (147-200) |
| LDL cholesterol,c median (IQR), mg/dL | 88 (68-113) | 87 (67-113) | 95 (74-119) | 93 (72-118) |
| LDL cholesterol ≥70 mg/dL | 29 195 (73) | 19 553 (72) | 71 983 (80) | 47 777 (79) |
| Systolic blood pressure, median (IQR), mm Hgc | 138 (128-150) | 138 (128-150) | 130 (121-140) | 130 (122-140) |
| Systolic blood pressure ≥130 mm Hg | 29 955 (74) | 20 268 (74) | 48 902 (54) | 33 374 (55) |
| Current smokingc | 5041 (12) | 3951 (14) | 9442 (10) | 7078 (12) |
| Medication use | ||||
| Aspirinc | 20 567 (51) | 13 452 (49) | 38 958 (43) | 24 500 (40) |
| Medicare Part D prescription drug coveragef | 28 348 (70) | 19 061 (70) | 61 064 (68) | 41 290 (68) |
| Antihypertensive usef | 25 561 (90) | 17 015 (89) | 48 442 (79) | 32 575 (79) |
| Statin usef | 19 517 (69) | 12 960 (68) | 37 089 (61) | 25 401 (62) |
| Model entryg | ||||
| Initial model visit with a primary care physician | 23 369 (58) | 16 466 (60) | 52 777 (59) | 37 796 (62) |
| Initial model visit with a cardiologist | 10 953 (27) | 7470 (27) | 23 801 (26) | 15 867 (26) |
| Time from model launch to initial model visit, median (IQR), d | 122 (55-265) | 157 (70-297) | 136 (64-282) | 168 (77-307) |
| Health care service use in the year before model entrye | ||||
| Total Medicare Parts A and B spending per beneficiary per month, median (IQR), $ | 241 (98-622) | 233 (93-601) | 205 (80-532) | 201 (77-525) |
| All-cause hospitalizations per 1000 people per year, mean (SD)h | 204 (747) | 201 (619) | 181 (636) | 189 (769) |
| CVD-specific hospitalizations per 1000 people per year, mean (SD)h | 49 (309) | 45 (271) | 39 (272) | 42 (321) |
| All-cause ED visits per 1000 people per year, mean (SD)h | 395 (1080) | 383 (969) | 377 (1202) | 367 (1199) |
| CVD-specific ED visits per 1000 people per year, mean (SD)h | 32 (238) | 32 (213) | 28 (259) | 26 (212) |
| Office visits per person per year, median (IQR) | 8 (5-13) | 8 (4-13) | 7 (4-12) | 7 (4-12) |
| Office visits per person per year with a practitioner listed on the organization’s Million Hearts Model application, median (IQR) | 2 (1-4) | 2 (1-4) | 2 (0-3) | 2 (1-4) |
Abbreviations: CVD, cardiovascular disease; ED, emergency department; LDL, low-density lipoprotein.
Based on data from the Medicare enrollment database.
Based on registry data submitted by the Million Hearts Model participating organizations, validated against data in the Medicare Enrollment Database. Because CVD risk score calculation differs for those with Black race vs non-Black race,1,11 CMS required model participants only to provide race information stating whether beneficiaries were Black or not Black. However, imputed race data from the RAND Medicare Bayesian Improved Surname Geocoding race and ethnicity file—which incorporates information from the Medicare Enrollment Database as well as name and address—suggest the model population with high and medium risk was 84% non-Hispanic White, 7% non-Hispanic Black, 4% Hispanic (of any race), and 4% Other (American Indian and Alaska Native, non-Hispanic Asian and Pacific Islander, or multiracial).
Based on data from the Million Hearts Data Registry.
The CVD risk score is the predicted probability of a myocardial infarction or stroke within 10 years expressed as a percentage (0%-100%). Risk scores were calculated based on demographic information (age, sex, and race), clinical information (blood pressure and lipid levels and diabetes status), smoking status, and use of antihypertensives, following the study by Goff et al.11 The study population limits to beneficiaries with a CVD risk score of at least 15%. The maximum observed risk score was 88% for high-risk beneficiaries and just less than 30% for medium-risk beneficiaries.
Based on Medicare Parts A and B claims.
Based on Medicare Part D claims.
Based on Million Hearts Data Registry data linked to specialty information in the National Plan & Provider Enumeration System.
Mean values per 1000 people are shown rather than the median values per person because the median values per person were all 0.