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

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Title: Home‐Based Primary Care: Beyond Extension of the Independence at Home Demonstration.
Authors: Rotenberg, James, Kinosian, Bruce, Boling, Peter, Taler, George, for the Independence at Home Learning Collaborative Writing Group
Source: Journal of the American Geriatrics Society. Apr2018, Vol. 66 Issue 4, p812-817. 6p. 3 Charts.
Subjects: Primary care, Home care services, Medical care for older people, Centers for Medicare & Medicaid Services (U.S.), Medical care cost control, Economics
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. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Home‐Based Primary Care: Beyond Extension of the Independence at Home Demonstration.
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  Data: <searchLink fieldCode="AR" term="%22Rotenberg%2C+James%22">Rotenberg, James</searchLink><br /><searchLink fieldCode="AR" term="%22Kinosian%2C+Bruce%22">Kinosian, Bruce</searchLink><br /><searchLink fieldCode="AR" term="%22Boling%2C+Peter%22">Boling, Peter</searchLink><br /><searchLink fieldCode="AR" term="%22Taler%2C+George%22">Taler, George</searchLink><br /><searchLink fieldCode="AR" term="%22for+the+Independence+at+Home+Learning+Collaborative+Writing+Group%22">for the Independence at Home Learning Collaborative Writing Group</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+the+American+Geriatrics+Society%22">Journal of the American Geriatrics Society</searchLink>. Apr2018, Vol. 66 Issue 4, p812-817. 6p. 3 Charts.
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  Data: <searchLink fieldCode="DE" term="%22Primary+care%22">Primary care</searchLink><br /><searchLink fieldCode="DE" term="%22Home+care+services%22">Home care services</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care+for+older+people%22">Medical care for older people</searchLink><br /><searchLink fieldCode="DE" term="%22Centers+for+Medicare+%26+Medicaid+Services+%28U%2ES%2E%29%22">Centers for Medicare & Medicaid Services (U.S.)</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care+cost+control%22">Medical care cost control</searchLink><br /><searchLink fieldCode="DE" term="%22Economics%22">Economics</searchLink>
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  Data: 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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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              Text: Apr2018
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