The Independence at Home demonstration showed mixed results for Medicare savings and utilization, but participating patients and caregivers reported high satisfaction with the home-based primary care that they received.
The Independence at Home (IAH) demonstration was launched in 2012 by the Centers for Medicare & Medicaid Services to test a payment incentive and service delivery model for providing home-based primary care to Medicare beneficiaries with chronic conditions and functional limitations. This report evaluates the effects of the payment incentive on Medicare spending and outcomes of health care use from the first five years of the IAH demonstration (2012-2017). It also examines changes that IAH practices made to improve care as well as beneficiary and caregiver satisfaction with care.
Over five years, the IAH payment incentive was shown to reduce emergency department visits by nearly five percent, and it was associated with reduced potentially avoidable hospital admissions in years three through five. This payment incentive also reduced total Medicare expenditures by $200 per beneficiary per month, but this decrease was not statistically significant. There was no evidence that the payment incentive affected mortality or entry into long-term care. Almost 95 percent of patients and caregivers in the demonstration reported high satisfaction with the home-based primary care services they received, citing accessibility and clinicians taking their opinions into account as reasons for their satisfaction.
While previous years of the IAH demonstration reported more statistically significant positive results, the mixed findings in this evaluation may have been affected by factors such as small participant numbers, data challenges, and lack of quality measures reporting. The demonstration will continue until the end of 2023.