Intensive Care Management for the Seriously Ill Elderly

Among the myriad of Medicare demonstrations, one is aimed at the very sickest Medicare beneficiaries to see if providing intensive care, including in the home, can reduce the cost of caring for these people.  CMS has announced the first year results for the demonstration, which appear positive.   (CMS Announcement)   This “Independence at Home” demonstration saved $25 million in health spending in the first year, an average of $3070 per beneficiary, while delivering more care in the home.  The 17 demonstration sites are clustered on the East coast, with several in Michigan and two in Texas, and they served about 8400 patients under the initiative.  Nine of these practices will get incentive payments totaling $11.7 million for meeting cost reduction and quality of care targets.  According to CMS, all 17 of the practices improved on at least three of the six quality measures.  In addition, CMS said that the beneficiaries in the demonstration had fewer 30-day hospital readmissions; had more follow-up contacts from the assigned practice within 48 hours of a hospital admission or discharge, or an emergency room visit; had more medication checks by the practice following a hospital discharge; had their care and treatment preferences documented more often and used inpatient hospital and ER services less for common conditions such as diabetes, hypertension, asthma, pneumonia or urinary tract infections.  CMS did not disclose how the analysis was done–was this a comparison to another matched cohort of beneficiaries; was it a study of utilization, cost and quality for the same beneficiaries before and after enrolling in the demonstration, and those details are important to understand the likely accuracy of the claimed results.  In addition, CMS did not give details on what it may have the cost the practices to participate in the demonstration and deliver the care in this manner; that may affect the real results to the practices.  We have seen in the ACO demonstration that even practices that got incentive payments found that the cost of participating was greater than the rewards.  But this appears to be a promising start.