U.S. News: Health Reform Testing New Medicare Programs for Home-Based Care

While more attention has been paid to certain provisions of the Affordable Care Act regarding health insurance or the creation of new state health insurance exchanges, the comprehensive health reform law has also spurred the development of new programs looking for ways to provide cost-efficient, quality care in a variety of settings—including those that are home- and community-based. 

U.S. News-Money reports

One of them, the Independence at Home (IAH) demonstration project, could have a huge impact on seniors with chronic illnesses. With growing numbers of older Americans, many of whom will post impressive longevity gains, rising healthcare costs are a national and personal problem. If the IAH test is successful, it would point the way toward lowering costs and also boost the broader provision of home-based healthcare services, thus helping seniors age in place in their homes and avoid institutionalized care.


The project, overseen by the government’s Center for Medicare and Medicaid Innovation (CMMI), has recently finished enrolling 19 medical practice groups throughout the country. Over the next three years, these groups expect to provide in-home care to about 10,000 people with multiple chronic health conditions. A detailed study by Medicare of 2008 treatments and expenses found that more than 90 percent of its expenses were to treat people with multiple chronic conditions.

“Many of these people have difficulty getting out of their home and getting to their doctor’s office,” says Rick Gilfillan, CMMI director. The goals of the IAH test are to see if in-home care can improve the health of participants, provide a more satisfactory care experience, and save money, he explains. Over time, practices that achieve all of these goals would be able to keep some of the money saved through reduced care expenses.

As an example of how at-home care would work, care professionals would go into the patient’s home and look at the medications they are taking. Often, people are prescribed additional medication when they are discharged from a hospital but either don’t fill these new prescriptions or even understand them. At-home care providers would check to see that prescriptions have been filled and that patients are taking the right drugs in the proper doses.


The demonstration period is three years. But Gilfillan says the CMMI doesn’t need to wait that long to set up additional tests. It has the authority, for example, to create additional demonstrations of approaches by some IAH practices that have produced very positive early results.

The IAH demonstration will include 19 organizations with prior experience in providing home care to chronically ill Medicare patients that are located in geographically diverse areas of the country. Even though there are restrictions on who can participate in the program, about 1.4 million Medicare beneficiaries would qualify if the program were to expand to all markets in the country. 

Read the full U.S. News piece.

Written by Alyssa Gerace