Yesterday, the Department of Health and Human Services (HHS) announced the selection of the first 16 Independence at Home programs under section 3024 of the Affordable Care Act. The Independence at Home program was designed and developed by Jim Pyles of Powers Pyles Sutter & Verville, PC, working with members of the American Academy of Home Care Physicians. Mr. Pyles worked closely with Congressman Ed Markey (D-MA) and Senator Ron Wyden (D-OR) to author the Independence at Home legislation. Interest in the IAH program is high as evidenced by the fact that over 130 organizations applied to participate.
IAH programs take primary care to Medicare beneficiaries in their homes if they are suffering from multiple chronic conditions, functional disabilities and have been users of high cost services in the past 12 months. Many of these beneficiaries find it difficult or impossible to get to a doctor’s office and often are transmitted to the emergency room in an ambulance after an acute exacerbation of a chronic illness. These are the 5%-25% of Medicare beneficiaries who account for 50%-85% of Medicare’s costs and are the fastest growing segment of the Medicare population. The IAH program holds IAH practices accountable for minimum savings of 5% annually, improved outcomes and patient/caregiver satisfaction—in return the practices are paid 80% of the savings they achieve beyond the first 5%. So IAH practices have an incentive to reduce costs by providing more continuous, coordinated care that allows the patients greater independence at home. The Independence at Home program has proven successful for over 30 years in the VA’s Home-Based Primary Care program that operates in more than 250 locations in every state and the District of Columbia and in numerous other IAH-style programs operated by care delivery systems and practitioners across the country. Those programs have successfully treated tens of thousands of patients and reduced hospitalizations by more than 60%, nursing home use by more than 80% and costs by 24%-60%.
“One of the features that I like most about this program”, said Jim Pyles, “is that it reverses the incentives under the existing fee-for-service and capitated payment systems to avoid the highest cost, most frail patients, and instead creates an incentive to enroll those patients and provide them with better health care for less.” The Independence at Home model also works in Medicare Advantage programs, Medicaid and private health insurance. Independence at Home is the only provision in the Affordable Care Act that requires a minimum level of savings annually on costs where they are the highest and received broad bipartisan Congressional support. It is anticipated that this program will expand rapidly in view of the Medicare Trustees’ estimate that Medicare will run out of money in 2024 unless significant savings are achieved.
For more information, contact Jim Pyles at 202.466.6550 or firstname.lastname@example.org.