The Independence at Home (IAH) Demonstration tests whether implementing a payment incentive and delivering home based primary care leads to reductions in overall spending and improvements in quality of care for chronically ill and disabled Medicare beneficiaries. Mathematica’s evaluation of the first six years of IAH provided no compelling evidence that the IAH payment incentive reduced Medicare spending or hospital use for high-need patients of practices participating in the demonstration. When examining dually eligible beneficiaries who received home-based primary care from any provider, Mathematica’s analysis found lower expenditures on institutional care and higher expenditures on home-based services—but no reduction in total Medicare or Medicaid spending.
This latest evidence builds on five years of evaluation findings that show the demonstration has not had the desired impacts. Still, there is evidence that home-based primary care may, in some cases, promote patient-centered care. In surveys conducted for the evaluation, patients of IAH practices and their caregivers reported high levels of satisfaction with home-based primary care, and a large majority preferred receiving primary care in their home to office visits. In addition, although many of the potential benefits of home-based primary care on spending and health outcomes have yet to be realized, its use has been growing, especially in assisted living facilities. Further, the COVID pandemic has spurred more interest in home-based medical care.
“To ensure home-based primary care improves health outcomes and is cost-effective, it will be important to determine how, where, and for whom it is most successful,” said Laura Kimmey, principal researcher at Mathematica and project director of the evaluation.