The Alliance PCP and Cardiology practices participating in our Million Hearts Model Program (MHM) have been working closely with our Alliance MHM Team to screen and risk stratify patients for inclusion in the intervention phase of this program. We have screened 6447 patients, of whom 1553 have been classified as “high risk” (i.e. have at least a 30% risk of having a first stroke or heart attack over the next 10 years). A significant component of this risk is the high prevalence of diabetes in our population as 31% of the overall population and 69% of the high-risk population are diabetic. The next step is for our providers to work with these patients on a plan to significantly lower their risk us-ing medications and life style changes.