Crain's Health Pulse
August 11, 2016
A Medicare pilot that provides primary care house calls for frail elderly patients while reducing costs saved more than $10 million, or $1,010 per beneficiary, in its second year, according to the Centers for Medicare and Medicaid Services.
The program, called Independence at Home, has 15 participating providers nationwide, including Northwell Health and Brooklyn-based Doctors on Call. Thanks to its success, it could soon be expanded to more patients. In July, a U.S. Senate bill was introduced to make Independence at Home a permanent, national Medicare program.
About $5.7 million has been returned to participating providers who meet metrics for quality and achieve cost savings, according to a CMS fact sheet.
The pilot program looks at six quality metrics: potentially preventable inpatient admissions; 30-day readmissions; potentially preventable emergency room visits; communication with patients within 48 hours upon admission and discharge from the hospital or ED; in-home medication reconciliation; and documentation of patient preferences.
In the second year of the program, which ran through May 2014 Northwell beat its spending target and qualified for an incentive payment. It spent $2,708 per-member per-month versus a target of $3,276, said Dr. Kristofer Smith, the program's former medical director. The three-year pilot was extended through September 2017.
Northwell Health relied on an interdisciplinary team made up of doctors, nurse practitioners, social workers and medical coordinators to provide care to 357 patients during that performance year, Smith said.
It also sent paramedics to patients' homes to help avoid emergency room visits and set up a system to get notified when patients were admitted to the emergency department or discharged from the hospital.
"We became increasingly sophisticated at responding within 24 hours when people called and said their loved one's health was deteriorating," Dr. Smith said.
Dr. Joseph Milano has since taken over as medical director of the program, which currently covers about 1,000 patients. Members of the care team work are working "at the top of their license," as the program shifts more of the care coordination responsibilities to care managers and social workers.
"We hope we can grow a little quicker, because the need is there," Milano said. "That's the ultimate goal—to reach more people," he said.
Doctors on Call, a practice led by Dr. Paul Rosenstock, also managed to lower patient costs. It spent $4,538 per patient versus the budgeted amount of $4,820. However, it didn't earn an incentive payment, which is based on achieving hitting quality metrics and generating savings, according to CMS