Home-Based Demonstration Model Saves Medicare $25 Million during First Year
NAHC President Says it is “More Evidence Home is the Center of Health Care,” Urges Expanded Focus on Chronic Care Management
June 22, 2015 08:02 AM
The Centers for Medicare & Medicaid Services (CMS) this week hailed a home-based health care demonstration project that resulted in Medicare savings during its first year as evidence of the benefits of caring for patients in their homes. In an announcement Thursday, CMS stated that the Independence at Home Demonstration, implemented under the Affordable Care Act, saved over $25 million during the demonstration’s first performance year.
In addition to the cost savings, the demonstration project resulted in fewer hospital readmissions and higher quality care.
Independence at Home Demonstration tests a service delivery and payment incentive model using home-based primary care teams to treat Medicare beneficiaries with chronic conditions. Directed by physicians and nurse practitioners, the teams are measured and provided incentives based on their performances improving health outcomes and reducing expenditures. The performance results and incentives payments for each of the 15 participating providers can be viewed here.
In announcing the results, CMS Acting Administrator Andy Slavitt stated the demonstration proves that caring for those with chronic conditions in their homes is higher quality and more affordable. “These results support what most Americans already want—that chronically ill patients can be better taken care of in their own homes. This is a great common sense way for Medicare beneficiaries to get better quality care with smarter spending from Medicare,” said Slavitt. “The Independence at Home Demonstration is one of the tools of the Affordable Care Act that can bring down the long-term cost of care in a patient-centered manner.”
Val J. Halamandaris, President and CEO of the National Association for Home Care & Hospice (NAHC), commended the Independence at Home Demonstration for focusing on and highlighting the benefits of caring for people in their homes. NAHC supports the Independence at Home Demonstration model, while also advocating for an expanded focus on chronic care management with a broader population than covered under Independence at Home.
“The results provide more evidence that home is the center of health care,” said Halamandaris. “I commend CMS for recognizing that caring for those with chronic conditions in their homes saves money and improves care. This demonstration is a good step in what needs to be an increased focus on home- and community-based care. Based on the results, Congress should take the next step and establish a separate care management benefit under Medicare for those with chronic conditions.”
NAHC recommends that Congress establish a separate care management benefit under Medicare for certain chronically ill patients, including those with chronic obstructive pulmonary disease, congestive heart failure, diabetes, and certain neurological disorders. In order to ensure a discipline-integrated, community care-based approach to care management, the service should be provided by professional nurses and others within home health agencies, under the guidance and supervision of the patient’s attending physician as a member of the care team. The services should include: 1) An interdisciplinary team approach to care management that includes physicians, nurses, therapists, medical social workers, and pharmacists; 2) Evidence-based care plan development; 3) Direct patient care services in the home setting; 4) The application of telehealth services for appropriate remote monitoring as needed by the individual patient; 5) Care counseling, care coordination, medication management, and oversight of services related to activities of daily living; 6) The use of interoperable electronic health care records and efficient electronic-based communication tools; 7) Patient education and support; and 8) Integration and support of informal caregivers such as family members.
As previously reported, in an indication of Congressional support for caring for those with chronic illness in their homes, the Senateand House Ways & Means Committeerecently passed legislation extending the demonstration project for another two years beyond the time-frame provided under the ACA.
Learn more about the Independence at Home Demonstration here.