Independence at Home Demonstration Performance Year 5 Results Fact Sheet

Home-based primary care allows health care providers to spend more one-on-one time with their patients, perform assessments in a patient’s home environment, and assume greater accountability for all aspects of patient care. This focus on timely and appropriate care is designed to improve the overall quality of care and quality of life for patients served, while lowering health care expenditures by avoiding costly hospital care and forestalling the need for care in institutional settings.

The Independence at Home (IAH) Demonstration is authorized by Section 1866E of the Social Security Act, as added by Section 3024 of the Affordable Care Act (P.L. 111-148), extended for two years by the Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015, and as further extended and amended by section 50301 of the Bipartisan Budget Act of 2018 (BBA) for an additional two years, which began on January 1, 2019. The IAH Demonstration tests a payment incentive and service delivery model for homebased primary care for Medicare fee-for-service (FFS) beneficiaries with multiple chronic illnesses. The Demonstration tests whether home-based primary care that is designed to provide comprehensive, coordinated, continuous, and accessible care to high-need patients and to coordinate health care across all treatment settings reduces preventable hospitalizations, readmissions, and emergency department visits; improves health outcomes commensurate with beneficiaries’ stage of chronic illness; improves the efficiency of care; reduces the cost of health care services; and achieves beneficiary and family caregiver satisfaction.

Beneficiaries’ care is monitored using several quality measures. A benchmark, called the spending target, estimates the amount that would have been spent for applicable beneficiaries in the absence of the Demonstration. Practices that reduce their applicable beneficiaries’ Medicare expenditures sufficiently below their spending targets may share in a portion of the difference between the actual expenditures and the spending target, referred to as an incentive payment. A practice’s incentive payment is adjusted based on its performance on a set of associated quality measures.

To view the full Summary of Results from Performance Year 5, click here.