Hypertension Treatment and Outcomes in the Era of Population Health, Coordinated Care, and Medicare Access and CHIP Reauthorization Act (MACRA)
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Article, see p 1617
SPRINT (Systolic Pressure Intervention Trial) studied whether treatment to a systolic blood pressure (SBP) goal of <120 mm Hg (intensive treatment) was superior to an SBP treatment goal of <140 mm Hg (standard treatment) in adults without diabetes mellitus who were ≥50 years of age at high risk for cardiovascular events.1 In this issue of Circulation, Bress and colleagues2 project the impact of implementation of the intensive strategy on all-cause mortality and serious adverse events (SAEs) in the US population. Implementing intensive treatment, with estimated improvements in mortality despite increases in SAEs, needs to be framed within the rapidly changing healthcare payment and delivery models in the United States.3
Two acts of Congress, the Patient Protection and Affordable Care Act of 2010 and the Medicare Access and CHIP Reauthorization Act of 2015,4 dramatically shifted the focus of healthcare delivery from fee-for-service to a value-based model with an underpinning that is patient-centered coordination of care.3 Regardless of the fate of the Patient Protection and Affordable Care Act, trends in health care put into motion by this legislation will continue. With the Medicare Access and CHIP Reauthorization Act, the Centers for Medicare & Medicaid Services gained critical tools to support its goal to link 50% of fee-for-service payments by 2018 to alternative payment and population-based care models such as accountable care organizations and patient-centered medical homes. Including growth in the private health insurance market, upward of 70 million people in the United States may be covered through these alternative payment models by 2020 and 150 million by 2025.5
These forces will affect hypertension management. Strong evidence suggests that team-based, coordinated care with shared decision making improves outcomes and reduces costs, particularly for hypertension.6,7 Coupled with current growth trends in population-based …