Independence at Home Demo Shows Improved Care and Lower Costs

Legislation | June 18, 2015

The positive results from the Independence at Home demonstration was a catalyst for a legislative victory. Both houses of Congress have passed the Medicare Independence at Home Medical Practice Demonstration Improvement Act, which would extend for 2 years the Independence at Home (IAH) program under way in 14 states. The Independence at Home (IAH) Demonstration showed higher quality care and lower Medicare expenditures in its first performance year.

The positive results from the Independence at Home demonstration led to a legislative victory. The Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (S. 971), sponsored by Sen. Ron Wyden (D-OR) was passed by the U.S. House of Representatives.  

The bill would extend for 2 years the Medicare home-care demonstrations taking place under the Independence at Home (IAH) program under way in 14 states. 

Without the extension, the IAH program would have ended by Aug. 31st. 

The U.S. Senate passed the bill on April 22. It now heads to President Obama, who is expected to sign it. 

LeadingAge has been an advocate for this program. It has promise to eventually become a permanent part of Medicare. 

Results of the Demonstration

The Centers for Medicare and Medicaid Services (CMS) announced that the Independence at Home (IAH) Demonstration showed higher quality care and lower Medicare expenditures in its first performance year.  

The Independence at Home Demonstration is intended to encourage the delivery of high quality primary care in a home setting. The multidisciplinary team approach is used to coordinate care. 

Results of the Independence at Home Demonstration: 1st Performance Year 

For the 1st performance year, 17 participating practices served over 8,400 Medicare beneficiaries. $11.7 million of incentive payments will be awarded to the 9 participating practices that succeeded in reducing Medicare expenditures and met designated quality goals for the first year of the demonstration.

The CMS analysis showed: 

  • The demonstration saved $25 million, an average of $3,070 per beneficiary.  
  • 17 participating practices improved quality in at least 3 of the 6 quality measures for the demonstration in the first performance year. 
  • 4 participating practices met all six quality measures. 
  • Medicare beneficiaries in the demo had  fewer hospital re-admissions within 30 days.
  • Medicare beneficiaries in the demo used inpatient hospital and emergency department services less for conditions such as diabetes, high blood pressure, asthma, pneumonia, or urinary tract infection.
  • Medicare beneficiaries in the demo had  follow-up contact from their provider within 48 hours of a hospital admission, hospital discharge, or emergency department visit.
  • Demo participants had  their medications identified by their provider within 48 hours of discharge from the hospital.
  • Demo participants had  their preferences documented by their provider.

Sylvia M. Burwell, secretary of the U.S. Department of Health and Human Services (HHS), set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018.

CMS has indicated that the 2nd year results of the IAH Demonstration will be published in November, and IAH participants believe those results will be even stronger. 

Independence at Home Demonstration: How to Participate

To participate in the Independence at Home Demonstration, Medicare beneficiaries must: 

  • Have 2 or more chronic conditions.
  • Have coverage from original, fee-for-service (FFS) Medicare.
  • Need assistance with 2 or more functional dependencies (e.g., walking or feeding).
  • Have had a non-elective hospital admission within the last 12 months.
  • Have received acute or subacute rehabilitation services in the last 12 months

LeadingAge Recommendations

LeadingAge has recommended to the U.S. Senate Finance Committee that the Independence At Home Demonstration become a chronic care coordination benefit under Medicare.  

We are urging the Republican leadership in the U.S. House of Representatives to schedule a vote on the Independence at Home extension legislation, S. 971 that has already passed in the Senate and received unanimous bipartisan approval in the House Ways and Means Committee.