Can Medicare deliver better care at home to older patients with multiple chronic conditions and save money in the process? Based on Year One practice results of Medicare’s Independence at Home Demonstration, the answer is a resounding “Yes.” In its first year, the Demonstration both improved health outcomes for patients with multiple chronic conditions and saved Medicare $25 million.
The Demonstration is funded through the Affordable Care Act with the goal of improving quality of care and quality of life for older patients with multiple care needs. It is designed to keep patients at home and out of institutions—be they hospitals or nursing home. The Demonstration gives doctors and nurse practitioners more time with their patients and allows them to assess their home environment. And, it is designed to improve both caregiver and patient satisfaction.
Patients in the Demonstration must be enrolled in traditional Medicare, have two or more chronic conditions and have been hospitalized in the prior 12 months. They receive comprehensive primary care tailored to their needs for a three-year period. The care team coordinates their care. The Centers for Medicare and Medicaid Services is tracking the patients’ care experiences through quality measures. Providers in the demonstration that succeed at reducing costs receive incentive payments.
Begun in 2012, fifteen sites throughout the country are engaged in this project, including Boston Medical Center, Cleveland Clinic Home Care Services, North-Shore Long Island Jewish Health Care and Dallas VPA.
This demonstration is one of a number of pilots Medicare is supporting to test ways of delivering care that allow older adults to age in place. Click here to read about another such project. Right now, other than through these demonstration projects, Medicare only covers limited home care services for patients needing physical therapy or nursing care and for whom leaving home requires a considerable and taxing effort.