Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Provider List File

The Provider List file contains the list of all NPIs enrolled in the model, including the activation and deactivation dates.

What does this file include? (variable highlights)

  • NPI of the Participating Provider
  • Provider First and Last Name
  • Model-Assigned Practice ID the provider is associated with
  • Practice Name
  • Practice TIN

A record represents a provider (NPI) who is enrolled in the registry.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Practice List File

The Practice List file contains the list of all practices enrolled in the model, including an indicator if the practice is active and the number of files submitted for the practice.

What does this file include? (variable highlights)

  • Model-Assigned Practice ID
  • Practice Billing TIN
  • Practice Location
  • Comma-Separated Lists of Affiliated Practice NPIs and CCNs (Facility Numbers)

A record represents a single physician practice (billing TIN).

The practice TIN can be linked to other Medicare data that contains TINs.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Visit File

The Visit file contains all data extracted to create a beneficiary visit, and includes both uploaded data and manually entered data from the model data collection registry. All generated risk scores and baseline groups are contained in this file. The file is generated at the visit level, with one row for each visit for each beneficiary.

What does this file include? (variable highlights)

  • Model-Assigned Practice ID
  • Model-Assigned Patient ID
  • Visit Date
  • Baseline CVD Risk Score
  • CVD Risk Score at the time of the visit
  • Baseline risk group (low, medium, high)

A record represents a patient at the time of a particular visit, and includes information such as visit date, baseline risk score, visit risk score, and baseline group.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Beneficiary Demographic File

The Beneficiary Demographic file contains all beneficiary demographic information entered via manual entry and upload to the model data collection registry. Additionally, partial beneficiary data that was created through the semi-annual beneficiary alignment validation process is also included and could be considered a data input method. The file is at the beneficiary level, with one record for each beneficiary. It’s possible for the same beneficiary to appear in the file twice, if two or more organizations tried to enroll the same beneficiary.

What does this file include? (variable highlights)

  • Beneficiary ID
  • Model-Assigned Patient ID
  • Patient Date of Birth
  • Patient Gender
  • Patient Race
  • Patient Ethnicity

A record represents a single beneficiary. Some beneficiaries may have more than one record if more than one organization tried to enroll them in the trial.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Final Clinical File

The Final Clinical file is a model-curated version of the information in the Raw Clinical data. Million Hearts® business rules are applied to the raw data and select information is extracted and translated into custom codes.

Note that clinical data excludes all “Incomplete” visits.

What is a clinical data element? Data fields that can be collected, utilized, or stored in various application systems.

What does this file include? (variable highlights)

  • Beneficiary ID
  • Model-Assigned Practice ID
  • Model-Assigned Patient ID
  • Provider NPI
  • Activity Date
  • Activity End Date
  • Provider NPI
  • Clinical Service Procedure Code
  • Clinical Service Procedure Modifier
  • Service Units

A record represents one clinical data element per beneficiary. Beneficiaries that have multiple clinical data elements will have multiple records.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.

The NPI can be linked to other records with NPI in this dataset and other CCW Medicare data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Raw Clinical File

The Raw Clinical file contains all visit and clinical data that was uploaded to the model’s data collection registry. This data is preserved as it was uploaded, therefore it may contain data that is not relevant for the Million Hearts® registry as the measures are defined. The file is at the clinical data element level and contains one row per clinical data element per beneficiary, using industry standard codes.

Note that this file excludes all manually entered data in the Million Hearts® registry.

What does this file include? (variable highlights)

  • Beneficiary ID
  • Model-Assigned Practice ID
  • Model-Assigned Patient ID
  • Provider NPI
  • Activity Date
  • Activity End Date
  • Provider NPI
  • Clinical Service Procedure Code
  • Clinical Service Procedure Modifier
  • Service Units

A record represents one clinical data element per beneficiary. Beneficiaries that have multiple clinical data elements will have multiple records.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.

The NPI can be linked to other records with NPI in this dataset and other CCW Medicare data.

Million Hearts® Cardiovascular Disease Risk Reduction Model

The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model was a randomized controlled trial that sought to bridge a gap in cardiovascular care by providing targeted incentives for health care practitioners to engage in beneficiary CVD risk calculation and population-level risk management. Instead of focusing on the individual components of risk, participating organizations engaged in risk stratification across a beneficiary panel to identify those at highest risk for atherosclerotic cardiovascular disease (ASCVD).

The Million Hearts® Cardiovascular Disease Risk Reduction Model used data-driven predictive modeling approaches to generate individualized risk scores and mitigation plans for eligible Medicare fee-for-service beneficiaries.

The data from the trial is released as a suite of seventeen linked data files. The data include detailed information about the beneficiaries, physician practices, specific providers and clinic visits. The files do not contain names, street addresses or contact information. However, they can be linked to other CMS files through the CCW beneficiary ID.

The following data files are included in the model:

  • Raw Clinical File - all visit and clinical data for beneficiaries as it was uploaded to the data collection registry by the provider
  • Final Clinical File - a model-curated version of the raw clinical data
  • Beneficiary Demographic File - demographic data submitted by the practice
  • Visit File – All data extracted to create a beneficiary visit, and includes the generated risk scores and baseline groups for each participating beneficiary
  • Practice List File - information about practices enrolled in the model
  • Provider List File - information about the providers (National Provider Identifiers) enrolled in the model
  • Alignment Files (11) – Point-in-time beneficiary alignment and program eligibility determination analytic file. This alignment validation process occurred semi-annually throughout the duration of the model.

For more information on the Million Hearts® Cardiovascular Disease Risk Reduction Model, visit the CMS Innovation Center website.

Abigail Franklin, MPH

Abigail Franklin joined ResDAC in February 2023.  She has prior experience as a Policy Analyst and a Mental Health Program & Policy Consultant for the Minnesota Department of Human Services as well as a provider of community mental health services.  Abigail earned a BA in Sociology from Cornell College and a Master's of Public Health in Public Health Administration and Policy with a concentration in Global Health from the University of Minnesota.  She served as a Peace Corps Volunteer in the Republic of Moldova where her interest in public health was sparked.

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