Headline

Federal home-based primary care demonstration showed mixed results on measures related to Medicare savings, care quality, and utilization for Medicare-only and dually eligible beneficiaries.

Background

Independence at Home (IAH) was a Centers for Medicare & Medicare Services Innovation Center demonstration, active from 2012 to 2023. This model tested a payment and delivery model for providing home-based primary care to Medicare beneficiaries with chronic conditions and functional limitations. This report evaluates the demonstration’s ninth year (2022) and its impact on health care spending and outcomes.

Findings

IAH beneficiaries had more primary care visits than the comparison group, with more visits conducted in-person than via telehealth due to changes in the prevalence of COVID-19. The demonstration also reduced total Medicare expenditures by $322 per beneficiary per month, with additional savings realized for Medicare-Medicaid dually eligible beneficiaries ($856 per beneficiary per month), but this decrease was not statistically significant. There was no evidence that the model resulted in reductions in hospitalizations or emergency department visits or improvements in quality of care, but it is likely that mortality decreased amongst beneficiaries.

Policy/Program Takeaways

The demonstration period for IAH has ended, and the evaluation showed mixed results. Future initiatives to expand access to home-based primary care programs can be informed by these findings.