The Centers for Medicare and Medicaid services announced results from the first performance year of its Independence At Home project on Thursday, calling the demonstration “positive and promising.” Evaluators found that participants saved over $25 million—on average, about $3,070 per beneficiary. CMS said all 17 participating practices improved quality in at least three of six quality measures and four practices improved quality on all six.

"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. "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."

Beneficiaries participating in the demonstration had:

  • Fewer 30-day readmissions
  • Follow-up from their provider within 48 hours of hospital admission, discharge or ER visit
  • Medications verified by their provider within 48 hours of hospital discharge
  • Preferences documented by their provider
  • Less use of ER and inpatient hospital services for diabetes, high blood pressure, asthma, pneumonia or urinary tract infection

The Independence At Home initiative serves 8,400 Medicare beneficiaries. In order to be accepted into the program, participating practices were required to demonstrate experience in providing care in the home to high-cost, chronically ill beneficiaries. Selected providers include primary care and other multidisciplinary teams led by physicians or nurse practitioners, are organized for the purpose of providing physicians services, and serve at least 200 beneficiaries.

Our Take: For years home health care and Private Duty (non-medical home care) firms have lobbied for their value by keeping older Americans out of the hospital. In this experiment, physicians appear to play a more direct role by the requirement that they are “organized for the purpose of providing physician services.” But the results here are striking: an average per beneficiary per month savings of $3,070 is likely to be noticed by policymakers.

Expect physician groups to take notice as well. The Visiting Physician’s Association—not to be confused with the not-for-profit Visiting Nurses Association—provides care in 11 states to 50,000 seniors annually. The company netted $7.8 million in practice incentive payments.

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