Under the Independence at Home Demonstration, the CMS Innovation Center will work with medical practices to test the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions. Additionally, the Demonstration will reward health care providers that provide high quality care while reducing costs.
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Home-based primary care allows health care providers to spend more time with their patients, perform assessments in a patient’s home environment, and assume greater accountability for all aspects of the patient’s care. This focus on timely and appropriate care is designed to improve overall quality of care and quality of life for patients served, while lowering health care costs by forestalling the need for care in institutional settings.
The Independence at Home Demonstration will build on these existing benefits by providing chronically ill patients with a complete range of primary care services in the home setting. Medical practices led by physicians or nurse practitioners will provide primary care home visits tailored to the needs of beneficiaries with multiple chronic conditions and functional limitations.
The Independence at Home Demonstration also will test whether home-based care can reduce the need for hospitalization, improve patient and caregiver satisfaction, and lead to better health and lower costs to Medicare.
Selected primary care practices will provide home-based primary care to targeted chronically ill beneficiaries for a three-year period. Participating practices will make in-home visits tailored to an individual patient’s needs and coordinate their care. CMS will track the beneficiary’s care experience through quality measures. Practices that succeed in meeting these quality measures while generating Medicare savings will have an opportunity to receive incentive payments after meeting a minimum savings requirement.
Participation in this home-based care demonstration is voluntary for Medicare beneficiaries.
Participating Practices Requirements
As part of their application, the participating practices were required to demonstrate experience providing home-based primary care to high-cost chronically ill beneficiaries. Participating practices include primary care practices and other multidisciplinary teams that:
- Are led by physicians or nurse practitioners
- Are organized for the purpose of providing physician services
- Have experience providing home-based primary care to patients with multiple chronic conditions and
- Serve at least 200 eligible beneficiaries.
The primary care teams also include physician assistants, pharmacists, social workers, and other staff.
- Practice Year Two Results Press Release
- Practice Year Two Results Fact Sheet
- Shared Savings Methodology (PDF)
- Actuarial Shared Savings Methodology (PDF)
- Regression Approach Methodology (PDF)
- Practice Year One Results (PDF)
- Practice Year One Results Press Release
- Independence at Home Fact Sheet (PDF) (updated: 07/2016)
- State-Based Initiatives Systematic Review of Lessons Learned (PDF)