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How the Independence at Home Demonstration is Good for Home Care. HCA Conference Call January 12, 2012. The Basics. Authorized by Section 3024 of the Affordable Care Act.
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How the Independence at Home Demonstration is Good for Home Care HCA Conference Call January 12, 2012
The Basics • Authorized by Section 3024 of the Affordable Care Act. • Tests a payment incentive and service delivery model that uses home-based primary care for Medicare FFS beneficiaries with multiple chronic illnesses. • The Demo will assess the effects of timely, in-home primary care on health costs, quality of care, and rates of preventable hospitalizations, hospital readmissions and ED visits • Deadline for application: February 6th, 2012
Can any physician practice participate? • No…a practice must have: • Have at least an average of 200 applicable beneficiaries. • 24/7 availability to carry out plans of care. • Electronic Health Information Systems. • Remote patient monitoring. • Mobile diagnostic technology.
IAH Medicare Beneficiaries… • Must be entitled to Part A and enrolled in Part B • NOT enrolled in a Medicare Advantage plan or PACE Program • Cannot be enrolled in a practice that is part of a Medicare Shared Savings Program
Applicable Beneficiaries… • At least two chronic illnesses • Must need assistance with two or more ADL’s • Has had a non-elective hospital admission in the last 12 months and has used acute or sub-acute rehab services in the last 12 months
Quality Measures • Assess patient utilization (re-hospitalization rate, ED visit rate) • Indicate aspects of health status (pain control, depression screening) • Highlight processes of care (contact with beneficiaries within 48 hrs of hospital admission/discharge, in-home safety assessments). • Some quality measures tied to incentive payments – some tied to performance monitoring.
IAH Spending • CMS will establish practice specific spending target. • The spending target for each practice will be risk adjusted and frailty adjusted to reflect each practice’s patient population using the following formula: Average FFS Cost in County of Residence * Trend * (Risk adjusted score + frailty factor)
IAH Savings • Savings will be calculated as the difference between each practice’s spending target and actual FFS costs • Each participating practice must meet a Minimum Savings Requirement (MSR) to be eligible to share in savings.
Opportunity for Home Care • MD’s will be in a person’s HOME environment identifying unmet needs that will help people remain independent. • Closer alignment and communication between physician practice and home care. • Practices must be available 24/7, have remote monitoring, and EMR. • Easier Face-to-Face?
Opportunity for Home Care • Quality Measures: • Focus on care transition activities • Aspects of health status • Process of care • Performance Monitoring: Caregiver stress, patient satisfaction, voluntary disenrollment rate, medication management/reconciliation, symptom management, screenings/assessments, patient preferences, caregiver/beneficiary goals.
MORE INFO • CMS Independence At Home Demo webpage. • Contact Us! • jfuccione@thinkhomecare.org • 617-482-8830