How the Independence at How the Independence at Home Demonstration is Good Home Demonstration is Good

for Home Carefor Home Care

HCA Conference CallHCA Conference Call

January 12, 2012January 12, 2012

The BasicsThe Basics Authorized by Section 3024 of the Affordable Care Authorized by Section 3024 of the Affordable Care

Act.Act.

Tests a Tests a payment incentivepayment incentive and service delivery and service delivery model that uses model that uses home-based primary carehome-based primary care for for Medicare FFS beneficiaries with multiple chronic Medicare FFS beneficiaries with multiple chronic illnesses.illnesses.

The Demo will assess the effects of timely, in-home The Demo will assess the effects of timely, in-home primary care on health costs, quality of care, and primary care on health costs, quality of care, and rates of preventable hospitalizations, hospital rates of preventable hospitalizations, hospital readmissions and ED visitsreadmissions and ED visits

Deadline for application: February 6Deadline for application: February 6thth, 2012, 2012

Can any physician practice Can any physician practice participate?participate?

NoNo…a practice must have:…a practice must have: Have at least an average of 200 applicable Have at least an average of 200 applicable

beneficiaries.beneficiaries.

24/7 availability to carry out plans of care.24/7 availability to carry out plans of care.

Electronic Health Information Systems.Electronic Health Information Systems.

Remote patient monitoring.Remote patient monitoring.

Mobile diagnostic technology.Mobile diagnostic technology.

IAH Medicare IAH Medicare Beneficiaries…Beneficiaries…

MustMust be entitled to Part A and be entitled to Part A and enrolledenrolled in Part B in Part B

NOTNOT enrolled in a Medicare enrolled in a Medicare Advantage plan or PACE ProgramAdvantage plan or PACE Program

CannotCannot be enrolled in a practice that be enrolled in a practice that is part of a Medicare Shared Savings is part of a Medicare Shared Savings ProgramProgram

Applicable Beneficiaries…Applicable Beneficiaries…

At least two chronic illnessesAt least two chronic illnesses

Must need assistance with two or more Must need assistance with two or more ADL’sADL’s

Has had a non-elective hospital admission Has had a non-elective hospital admission in the last 12 months and has used acute or in the last 12 months and has used acute or sub-acute rehab services in the last 12 sub-acute rehab services in the last 12 monthsmonths

Quality MeasuresQuality Measures

Assess patient utilization (re-hospitalization rate, Assess patient utilization (re-hospitalization rate, ED visit rate)ED visit rate)

Indicate aspects of health status (pain control, Indicate aspects of health status (pain control, depression screening)depression screening)

Highlight processes of care (contact with Highlight processes of care (contact with beneficiaries within 48 hrs of hospital beneficiaries within 48 hrs of hospital admission/discharge, in-home safety assessments).admission/discharge, in-home safety assessments).

Some quality measures tied to incentive payments Some quality measures tied to incentive payments – some tied to performance monitoring.– some tied to performance monitoring.

Quality Measures - Quality Measures - continuedcontinued

IAH SpendingIAH Spending

CMS will establish practice specific spending target.CMS will establish practice specific spending target.

The spending target for each practice will be risk The spending target for each practice will be risk adjusted and frailty adjusted to reflect each adjusted and frailty adjusted to reflect each practice’s patient population using the following practice’s patient population using the following formula:formula:

Average FFS Cost in County of Residence Average FFS Cost in County of Residence * *

Trend Trend * *

(Risk adjusted score + frailty factor)(Risk adjusted score + frailty factor)

IAH SavingsIAH Savings

Savings will be calculated as the difference between Savings will be calculated as the difference between each practice’s spending target and actual FFS costseach practice’s spending target and actual FFS costs

Each participating practice must meet a Minimum Each participating practice must meet a Minimum Savings Requirement (MSR) to be eligible to share in Savings Requirement (MSR) to be eligible to share in savings.savings.

Opportunity for Home CareOpportunity for Home Care

MD’s will be in a person’s HOME MD’s will be in a person’s HOME environment identifying unmet needs that environment identifying unmet needs that will help people remain independent.will help people remain independent.

Closer alignment and communication Closer alignment and communication between physician practice and home between physician practice and home care.care.

Practices must be available 24/7, have Practices must be available 24/7, have remote monitoring, and EMR.remote monitoring, and EMR.

Easier Face-to-Face?Easier Face-to-Face?

Opportunity for Home CareOpportunity for Home Care

Quality Measures:Quality Measures: Focus on care transition activitiesFocus on care transition activities Aspects of health statusAspects of health status Process of careProcess of care

Performance Monitoring: Caregiver stress, Performance Monitoring: Caregiver stress, patient satisfaction, voluntary disenrollment patient satisfaction, voluntary disenrollment rate, medication management/reconciliation, rate, medication management/reconciliation, symptom management, symptom management, screenings/assessments, patient preferences, screenings/assessments, patient preferences, caregiver/beneficiary goals.caregiver/beneficiary goals.

MORE INFOMORE INFO

CMS Independence At Home Demo wCMS Independence At Home Demo webpage.ebpage.

Contact Us!Contact Us! jfuccione@thinkhomecare.orgjfuccione@thinkhomecare.org 617-482-8830617-482-8830