Evaluation of the Independence at Home Demonstration: An Examination of the First Four Years

Evaluation of the Independence at Home Demonstration: An Examination of the First Four Years

Published: May 23, 2019
Publisher: Princeton, NJ: Mathematica Policy Research
Associated Project

Evaluation of the Independence at Home Demonstration

Time frame: 2012-2023

Prepared for:

U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation


Valerie Cheh

Catherine McLaughlin

Jay Crosson

Jiaqi Li

Shannon Heitkamp

Christine Cheu

Tyler Fisher

Bonnie Harvey

Hope Johnson

Sam Zhang

Mariel Finucane

Angela Eckstein

Key Findings
  • The probability that the demonstration payment incentive decreased expenditures by at least $100 per beneficiary per month—about 2 percent of the average—over the course of four years was just 29 percent.
  • We found no evidence that the demonstration payment incentive reduced hospital admissions or the probability of having an unplanned hospital readmission over the four-year demonstration period. However, emergency department visits and potentially avoidable hospitalizations decreased for IAH beneficiaries.
  • Home-based primary care, as delivered in the Medicare program to chronically ill and functionally limited patients, did not lower Medicare expenditures relative to office-based care. Instead, we found that home-based primary care led to expenditures higher in total than those for comparison beneficiaries.

This report describes the implementation and impacts of the Independence at Home (IAH) demonstration over its first four years. The report examines the effects of the demonstration payment incentive on: (1) Medicare expenditures and health care use; (2) how IAH practices changed the way they delievered care during the demonstration and whether those changes affected the quality of care; and (3) how IAH beneficiaries and their caregivers perceived the care they received. Also, the report assesses whether home-based primary care reduces Medicare expenditures and hospital use for chronically ill, functionally limited patients who start home-based primary care.


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