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

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

Published: Nov 30, 2021
Publisher: Mathematica
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

Key Findings
  • There was no compelling evidence that payment incentive reduced Medicare expenditures, hospital admissions, or emergency department visits in Year 6.
  • Although home-based primary care recipients received more services in the home and fewer services in nursing facilities, receiving home-based primary care had no effect on Medicare or Medicaid expenditures for dually eligible beneficiaries.
  • Receiving home-based primary care was associated with lower Medicare expenditures during the last three months of life mainly because of lower inpatient expenditures.

This report describes the implementation and impacts of the Independence at Home (IAH) demonstration with a focus on demonstration Year 6. The report examines the effects of the demonstration payment incentive on: (1) Medicare expenditures, hospital use, and health outcomes; and (2) how IAH practices changed the way they delivered care during the demonstration and whether those changes affected the quality of care. Also, the report assesses whether home-based primary care reduces Medicare expenditures and hospital use for chronically ill, functionally limited patients dually eligible for Medicare and Medicaid who start home-based primary care. Finally, the report examines the association between home-based primary care use and end-of-life expenditures by chronically ill, functionally limited patients.

This appendix provides technical details for the report.

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