Support Builds for Independence at Home Demonstration

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Rhonda Oakes By Rhonda Oakes 
Regulatory Analyst, Change Healthcare
Independence at Home Demonstration

A recently introduced bipartisan Senate bill to make the Independence at Home (IAH) Demonstration project permanent for Medicare recipients already is gaining widespread industry support.

The National Association for Home Care & Hospice (NAHC), the National Coalition on Health Care, the American Academy of Home Care Medicine and Compassion & Choices are among the organizations that already have endorsed the bill. Introduced July 6 by Senators Edward Markey (D-Mass.), John Cornyn (R-Texas), Michael Bennet (D-Colo.) and Rob Portman (R-Ohio), the legislation would make permanent the pilot home-based primary care Medicare model that has had initial success. A companion bill is expected to be filed in the House of Representatives.

The three-year demonstration project from the Centers for Medicare & Medicaid Services (CMS) already has been extended, but it cannot be expanded without congressional action. In its first full year of the program, CMS saved on average just over $3,000 per beneficiary per year while improving care quality. Nine physician practices earned $12 million in bonuses while saving CMS a similar amount of money.

Lowest-cost, Preferred Care Setting

Expenditures for home care services represent a small percentage of overall healthcare spending, and per incident costs are generally lower in outpatient settings. Bringing all types of care, including physician and home health visits, to patient homes makes a lot of sense from financial, care and patient satisfaction standpoints.

Since 2011, the demonstration has served 90,000 Medicare beneficiaries suffering from multiple chronic conditions such as Alzheimer’s, congestive heart failure, and diabetes. A 2014 study of one Independence at Home study showed a 17% reduction on average in Medicare costs over two years while slashing the incidence of hospitalizations, ED visits, specialty provider visits, and nursing home stays among those served by the program.

NAHC supports IAH as part of an expanded focus on chronic care management for populations beyond those already covered in the Independence at Home Demonstration. NAHC President Val J. Halamandaris calls it “a good step in what needs to be an increased focus on home and community-based care.”

Evidence continues to build that care delivered in patient homes can help reduce the use of costlier services while delivering higher quality outcomes and better patient quality of life. Currently, the IAH initiative is in 13 states with 16 organizations participating.  We’ll track the proposed bill and provide updates because this is an excellent opportunity for home health agencies.

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