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

Publisher: Princeton, NJ: Mathematica Policy Research
May 23, 2019
Authors
Laura Kimmey, Michael Anderson, Valerie Cheh, Evelyn Li, Catherine McLaughlin, Linda Barterian, Jay Crosson, Cara Stepanczuk, Lori Timmins, Jiaqi Li, Shannon Heitkamp, Christine Cheu, Tyler Fisher, Bonnie Harvey, Hope Johnson, Beny Wu, Sam Zhang, Mariel Finucane, and 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.

Appendices.

Project

Evaluation of the Independence at Home Demonstration

Funders

U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

Time Frame

2012-2017

Senior Staff

Michael Anderson
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Lori Timmins
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Evelyn Li
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Beny Wu
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Mariel Finucane
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Linda Barterian
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Laura Kimmey
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Valerie Cheh
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Catherine McLaughlin
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