Medicare’s Independence at Home Program Posts Disappointing Results

Not every program promoting home-based care has been a clear-cut success.

In the sixth year of Medicare’s Independence at Home Demonstration program, the initiative saved $41 per member per month, an amount that CMS says was not statistically significant and was lower than the savings the program produced in earlier years.

The 18 primary care practices in the program could earn incentive payments if their patients’ Medicare expenditures were lower than a given target and if they met the standards for certain quality measures.

Results of the evaluation of the demonstration’s first six years provide no compelling evidence that the payment incentive measurably reduced total Medicare expenditures or hospital use, CMS said in a report in November. Moreover, many of the physician practices did not meet standards for all six quality measures tied to payment, even though doing so would have increased their payments. Six of the practices that started the program had dropped out by the sixth year, the report showed.

The participating Medicare members are similar to those in the Program of All-Inclusive Care for the Elderly (PACE) program in that the beneficiaries needed to have at least two chronic conditions and required help from another person to complete at least two activities of daily living. Also, they needed to have a hospital admission and used acute or subacute rehabilitation services, both in the past 12 months.

CMS’ report shows that older adults and particularly those who are frail need more than primary care to stay in their homes. Some Medicare members need someone in their home who can cook, do laundry or ensure that doorways are wide enough for a wheelchair or walker.

By design, the Independence at Home program is more limited in what services it delivers to participants compared with the PACE. Physicians and other members of multidisciplinary teams serving PACE participants are responsible for delivering the full continuum of medical and long-term care services including case management services. PACE participants also can join activities and get services at adult day care centers. Because the Independence at Home program is less comprehensive, problems like reducing people’s risk of falling (removing throw rugs, adding handrails) may not get the attention they deserve.