Home-Based Care Program is a $25 Million Success for Medicare

There’s now more evidence that robust in-home care can improve health outcomes while lowering costs to the U.S. health care system. A demonstration program to increase in-home primary care for patients with chronic conditions netted $25 million in savings for Medicare in its first year, the Centers for Medicare & Medicaid Services announced Thursday.

The Independence at Home demonstration was a payment model established under the Affordable Care Act, and it involves 17 participating primary care practices. They make home visits to beneficiaries with chronic conditions, coordinate their care, and track results through quality measures. If they meet a minimum savings threshold while also meeting quality measures, they are eligible to receive incentive payments.

All the participating practices improved in at least three of the six quality measures being tracked, and four of the participants met all six quality measures, CMS stated Thursday. The agency will award incentive payments totaling $11.7 million to nine practices that met quality goals and reduced expenditures. The largest payment, of more than $2.9 million, will go the Visiting Physicians Association (VPA) in Flint, Michigan.

The overall savings achieved in the first year of the program—from June 2012 to June 2013—averaged about $3,000 per participating beneficiary, according to CMS.

The participants also, on average, experienced fewer hospital readmissions within 30 days and used hospital emergency departments less frequently for conditions such as diabetes, high blood pressure and pneumonia.

“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 CMS Acting Administrator Andy Slavitt, in a prepared statement. “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.”

The American Academy of Home Care Medicine called the results “exceptionally good news.” The Academy called on the House of Representatives to pass an extension of the demonstration program; a two-year extension already has been approved by the Senate and has made its way out of the House Ways and Means committee.

Another successful practice in the demonstration was Housecall Providers, based in Portland, Oregon. It is one of the practices that met all six quality measures for reimbursement, and received $1.2 million as its share of the cost savings, the company stated.

“The study results confirm what we have believed for 20 years – that home-based medicine for the highest utilizers of Medicare services delivers better care and better health at a lower cost,” said Terri Hobbs, executive director of Housecall Providers, in a written statement. “This is a turning point for the way this population receives medical care in the future.”

Written by Tim Mullaney