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J Am Geriatr Soc. 2018 Apr;66(4):812-817. doi: 10.1111/jgs.15314. Epub 2018 Feb 23.

Home-Based Primary Care: Beyond Extension of the Independence at Home Demonstration.

Author information

1
Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
2
Geriatrics and Extended Care Data Analysis Center, Cpl Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
3
Center for Health Equity Research and Policy, Cpl Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
4
Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
5
Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois.
6
Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia.
7
Division of Geriatrics, Medstar, Washington, District of Columbia.
8
School of Medicine, Georgetown University, Washington, District of Columbia.

Abstract

The Independence at Home (IAH) Demonstration Year 2 results confirmed that the first-year savings were 10 times as great as those of the pioneer accountable care organizations during their initial 2 years. We update projected savings from nationwide conversion of the IAH demonstration, incorporating Year 2 results and improving attribution of IAH-qualified (IAH-Q) Medicare beneficiaries to home-based primary care (HBPC) practices. Applying IAH qualifying criteria to beneficiaries in the Medicare 5% claims file, the effect of expanding HBPC to the 2.4 million IAH-Q beneficiaries is projected using various growth rates. Total 10-year system-wide savings (accounting for IAH implementation but before excluding shared savings) range from $2.6 billion to $27.8 billion, depending on how many beneficiaries receive HBPC on conversion to a Medicare benefit, mix of clinical practice success, and growth rate of IAH practices. Net projected savings to the Centers for Medicare and Medicaid Services (CMS) after routine billing for IAH services and distribution of shared savings ranges from $1.8 billion to $10.9 billion. If aligning IAH with other advanced alternative payment models achieved at least 35% penetration of the eligible population in 10 years, CMS savings would exceed savings with the current IAH design and HBPC growth rate. If the demonstration were simply extended 2 years with a beneficiary cap of 50,000 instead of 15,000 (as currently proposed), CMS would save an additional $46 million. The recent extension of IAH, a promising person-centered CMS program for managing medically complex and frail elderly adults, offers the chance to evaluate modifications to promote more rapid HBPC growth.

KEYWORDS:

Medicare costs; frail elderly adults; home-based primary care; policy

PMID:
29473945
DOI:
10.1111/jgs.15314
[Indexed for MEDLINE]

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