Affordable Care Act payment model saves more than $25 million in the first performance year

RTI International-supported model improved care, lowered costs


BALTIMORE, MARYLAND— The Centers for Medicare & Medicaid Services (CMS) today announced positive and promising results from the first performance year of the Independence at Home Demonstration, including both higher quality care and lower Medicare expenditures. RTI International supported the design, development and implementation for the Independence at Home Demonstration.   

The CMS analysis found that Independence at Home participants saved over $25 million in the demonstration's first performance year – an average of $3,070 per participating beneficiary per year – while delivering high quality patient care in the home. CMS will award incentive payments of $11.7 million to nine participating practices that succeeded in reducing Medicare expenditures and met the designated quality measures for the first year of the demonstration.  

"This demonstration is distinguished by two factors: targeting a high-need population and focusing on delivering primary care in the home to help people, who would have trouble getting to a doctor's office, stay out of the hospital and avoid the emergency room," said Edith G. Walsh, director of Aging, Disability and Long-Term Care at RTI and the project's director. 

According to CMS' analysis, all 17 participating practices improved quality in at least three of the six quality measures for the demonstration in the first performance year. Four participating practices met all six quality measures. Medicare beneficiaries who are participating in Independence at Home practices, on average: 

  • Have less hospital readmissions within 30 days; 
  • Have follow-up contact from their provider within 48 hours of a hospital admissions, hospital discharge, and emergency department visit; 
  • Have all their medications identified by their provider within 48 hours of discharge from the hospital; 
  • Have all of their preferences documented by their provider; and
  • Use inpatient hospital and emergency department services less for conditions such as diabetes, congestive heart failure, and chronic obstructive pulmonary disease.

The Independence at Home Demonstration provides chronically ill patients with a complete range of primary care services in the home setting. In the first performance year, 17 participating practices provided care to over 8,400 Medicare beneficiaries. 

RTI and its subcontractor Actuarial Research Corporation, support the demonstration by monitoring practice performance and expenditures, providing ongoing technical assistance, and calculating savings sharing. 

The Independence at Home Demonstration is part of the innovative framework established by the Affordable Care Act to move our health care system toward one that rewards doctors based on the quality, not quantity, of care they give patients. The Administration earlier this year announced the ambitious goal of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016 and 50 percent of payments by 2018. 

To learn more about the Independence at Home Demonstration, including individual practice results, visit: http://innovation.cms.gov/initiatives/Independence-at-Home/.