title: Projected Savings and Workforce Transformation from Converting Independence at Home to a Medicare Benefit.
abstract: The Independence at Home (IAH) Demonstration Year 1 results have confirmed earlier studies that showed the ability of home-based primary care (HBPC) to improve care and lower costs for Medicare's frailest beneficiaries. The first-year report showed IAH savings of 7.7% for all programs and 17% for the nine of 17 programs that surpassed the 5% mandatory savings threshold. Using these results as applied to the Medicare 5% claims file, the effect of expanding HBPC to the 2.2 million Medicare beneficiaries who are similar to IAH demonstration participants was projected. Total savings ranged from $12 billion to $53 billion depending on the speed and extent of dissemination of HBPC among this IAH-like population. Using a fixed growth rate, as hospitalists experienced in their first decade, 35% coverage would be achieved at the end of 10 years, with total 10-year savings through IAH reaching $37.5 billion and $17.3 billion accruing to the Centers for Medicare and Medicaid Services as a net reduction in overall expenditures, with $12.6 billion from Medicare Parts A and B savings.
authors.affiliation: Division of Geriatrics, University of Pennsylvania, and Geriatrics and Extended Care Data Analysis Center, Cpl. Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: Bruce
authors.initials: B
authors.lastname: Kinosian
authors.affiliation: Division of Geriatrics, Department of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia.
authors.forename: George
authors.initials: G
authors.lastname: Taler
authors.affiliation: Division of Geriatrics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Peter
authors.initials: P
authors.lastname: Boling
authors.affiliation: JEN Associates, Cambridge, Massachusetts.
authors.forename: Dan
authors.initials: D
authors.lastname: Gilden
mesh_terms: D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy*; D017046:Cost Savings / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D016330:Frail Elderly; D006301:Health Services Needs and Demand / Q000191:economics; D006280:Health Workforce / Q000191:economics*; D006699:Home Care Services / Q000191:economics*; D006792:House Calls / Q000191:economics; D006801:Humans; D057187:Independent Living / Q000191:economics*; D008297:Male; D006278:Medicare / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics; D014481:United States
keywords: home- based primary care; housecalls; share savings