INDEPENDENCE AT HOME The Future of Medicare

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INDEPENDENCE AT HOMEThe Future of Medicare

• James C. Pyles, Esq.
• Powers, Pyles, Sutter Verville, PC
• April 30, 2008

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The Independence at Home Concept

• Addressing the highest costs first
• Producing better outcomes
• Providing care that is tailored to the patients
  condition
• Providing care that patients want
• Using available expertise

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The Good News

• 15 of Medicare beneficiaries account for 85 of
  costs
• Care is fragmented, inconsistent, reactive to
  acute conditions
• The chronically ill the fastest growing segment
  of the beneficiary population
• Growth in cost of Medicare is unsustainable

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The Independence at Home ProgramWhat Is It?

• Trained teams of health care professionals
  directed by qualified physicians providing
  continuous care to beneficiaries in their places
  of residence.
• Teams comprised of nurse practitioners,
  physicians assistants nurses and others employed
  directly or under contract.
• IAH assessment and IAH care plan.

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Who Can Participate?

• Qualified physicians, physician groups and
  providers
• Any combination
• Three-year agreement

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Who Is Eligible?

• Beneficiaries who
• Have 2 or more of nine chronic conditionscongesti
  ve heart failure, diabetes, COPD, ischemic heart
  disease, peripheral arterial disease, stroke,
  Alzheimers Disease and other dementias
  designated by the Secretary, pressure ulcers,
  hypertension, other high cost chronic conditions
  designated by the Secretary
• In past 12 months have had non-elective inpatient
  hospital services, services in an ER, and
  extended care services, services in a
  rehabilitation facility or home health services
• An inability to perform without assistance 2 or
  more ADLs

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What Services Must Be Provided?

• Geriatric assessment and coordination of all care
• IAH plan/self care education and preventive
  care/education of caregivers and family
• Monitoring and management of medications
• Referral to social services
• 24/7 availability to deal with patient
  emergencies
• Access to phlebotomy and ancillary lab and
  imaging
• Provision for electronic medical records and
  electronic health information

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Performance Specifications

• Patient satisfaction
• Good outcomes
• Minimum 5 savings

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Payment

• IAH assessment and monthly fee
• 80 of savings above 5
• Providers must be able to meet financial risk
  requirements

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Demonstration Project

• 13 high cost statesCalifornia, New York, New
  Jersey, Florida, Texas, Maryland, Massachusetts,
  Connecticut, Rhode Island, Nevada, Illinois,
  Louisiana, Pennsylvania, District of Columbia
• 13 additional representative states
• Three years