Independence at Home Payment Model Didn't Yield Significant Savings, Quality Results for Medicare: Study

Fierce Healthcare
 
The Independence at Home payment model hasn’t improved quality or generated statistically significant savings for Medicare over the past six years, a new study found.
 
The study, published last week by Mathematica, looked at a model that gives physicians incentive payments for lowering Medicare costs and meeting a set of quality measures. The goal was to improve care coordination for patients especially after they leave the hospital.
 
“When examining dually eligible beneficiaries who received home-based primary care from any providers, 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,” according to a release on the firm’s analysis.
 
Mathematica examined its evaluation report in the sixth year of the model in 2019. The model was first created in 2010 and started in June 2012.
 
It found that the model’s payment incentive didn’t affect total Medicare spending in the sixth year of the model. Mathematica found the incentives led to a 1% decline in Medicare expenditures in year six of the model.
 
The reduction in total Medicare expenditures was driven largely by the largest service category of inpatient expenditures, which reduced spending by 4.1%.
 
The model also didn’t have an impact on hospital admissions the same year.
 
“We estimated that the payment incentive increased hospital admissions by 25 per 1,000 beneficiaries (1.4%) but this increase was not statistically significant,” the report said.
 
The analysis comes as the Center for Medicare and Medicaid Innovation (CMMI) has undertaken a strategic refresh of all its payment models, with a renewed focus on improving equity and becoming more streamlined. CMMI also wants to ensure reductions in spending aren’t the only metric models are evaluated against.
 
CMMI has also expanded several new models aimed at improving home care. Back in June, the Centers for Medicare & Medicaid Services proposed expanding nationwide a home health value-based purchasing model that rewards home health agencies for meeting certain quality metrics and spending initiatives.