An independent analysis found that demonstrations aimed at providing health insurance beneficiaries with better family primary care services and cutting costs did not result in program savings or significant improvements in care.

The sixth year of the demonstration was called Independent at home According to research published last week by consulting firm Mathematica, the total monthly medical insurance expenditure of each beneficiary in 2019 is estimated to be reduced by 1%. An early Mathematica evaluation of the program for the fourth year found that the cost savings were not statistically significant. Although the fifth year of 2018 did reduce costs, these costs were driven by a site’s withdrawal from the program after that year.

Mathematica found that the rewards paid to participating providers will not affect the possibility of hospital admissions, emergency room visits, possible avoidable hospital use, mortality, or access to institutions for long-term care in 2019. Many practices do not meet the standards of all six quality measures related to payments.

Laura Kimmey, Mathematica’s principal researcher and director of evaluation, said: “The total amount of signals in the data tells us that, unfortunately, this payment incentive does not seem to have the desired effect.”

Although the Center for Medicare and Medicaid Services has reported Savings In each of the six years of demonstration, Mathematica used a different method to focus on the effectiveness of payment incentives.

Congress create Kimmey said that the demonstration of home independence through the “Affordable Care Act” was expanded in 2015 and 2018. The demonstration currently continues until 2023. Compared with other model models, Congress has the greatest say in the future of the plan.

Mathematica also found no evidence that family primary care resulted in lower medical insurance or Medicaid costs for dual-eligibility beneficiaries. These patients have relatively low institutional care expenditures, but household service expenditures have increased.

Although the expenditures for medical insurance participants who receive family primary care in the last three months of life are indeed lower, the overall cost is actually higher in the last six and 12 months of life. But the increase in home care expenses was offset by the decrease in nursing home expenses.

patient Interest in home care Growing. Medicare registrants interviewed by the Mathematica research report that they are very satisfied with home primary care, and many people prefer it to office visits.

Kimmey said: “For some patients and some caregivers really like this particular type of care, who may benefit the most, there is still a lot to know.”

The demo is applicable to a small group of beneficiaries, which means Mathematica cannot draw conclusions about how payment incentives will affect patients served by other beneficiaries or providers who did not participate in the demo-especially in the 2019 demo 12 Five of these practices are operated by the same company.

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The chairman of the organization, Bill Domby, wrote in an email that the National Home Care and Hospice Association, which supports home independence, urged policymakers not to abandon the demonstrations.

“we believe [Independence at Home] Before taking any hasty action, further analysis is needed. Even though it may not show Medicare savings, it still provides care management value for patients,” Dombi wrote.


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