Independence at home Medical Practice Demonstration Program364
The Secretary will conduct a demonstration program to test a payment incentive and service delivery model that utilizes a physician and nurse practitioner directed home-based primary care teams designed to reduce expenditures and improve health outcomes for applicable beneficiaries365 in the provision of items and services.366 The program will test whether such a model, which is accountable for providing comprehensive, coordinated, continuous and accessible care to high-need populations at home and coordinating health care across all treatment settings,367 results in: reducing preventable hospitalizations;368 preventing hospital readmissions;369 reducing emergency room visits;370 improving health outcomes commensurate with the beneficiaries’ stage of chronic illness;371 improving the efficiency of care, such as by reducing duplicative diagnostic and laboratory tests;372 and achieving beneficiary and family caregiver satisfaction.373
An independence at home medical practice374 must use electronic health information systems, remote monitoring and mobile diagnostic technology.375 The entity will report on quality measures and such data as the Secretary determines is appropriate to monitor and evaluate the demonstration program.376 The Secretary will evaluate each independence at home medical practice under the program to assess whether the practice achieved the results discussed above,377 and will monitor data on quality of services after an applicable beneficiary discontinues receiving services through a qualifying practice.378 The Secretary will conduct an independent evaluation of the demonstration program and submit to Congress a final report including best practices under the program, which will include an analysis of the program on coordination of care, applicable beneficiary access to services, and the quality of health care services provided.379
Footnotes
- 364. Social Security Act § 1866E, 42 U.S.C. 1395cc-5.
- 365. “Applicable beneficiary” is defined in Social Security Act § 1866E(d)(1), 42 U.S.C. 1395cc-5(d)(1).
- 366. Social Security Act § 1866E(a)(1), 42 U.S.C. 1395cc-5(a)(1).
- 367. Social Security Act § 1866E(a)(2), 42 U.S.C. 1395cc-5(a)(2).
- 368. Social Security Act § 1866E(a)(2)(A), 42 U.S.C. 1395cc-5(a)(2)(A).
- 369. Social Security Act § 1866E(a)(2)(B), 42 U.S.C. 1395cc-5(a)(2)(B).
- 370. Social Security Act § 1866E(a)(2)(C), 42 U.S.C. 1395cc-5(a)(2)(C).
- 371. Social Security Act § 1866E(a)(2)(D), 42 U.S.C. 1395cc-5(a)(2)(D).
- 372. Social Security Act § 1866E(a)(2)(E), 42 U.S.C. 1395cc-5(a)(2)(E).
- 373. Social Security Act § 1866E(a)(2)(G), 42 U.S.C. 1395cc-5(a)(2)(G).
- 374. “Independence at home medical practice” is defined in Social Security Act § 1866E(b)(1)(A), 42 U.S.C. 1395cc-5(b)(1)(A).
- 375. Social Security Act § 1866E(b)(1)(A)(vi), 42 U.S.C. 1395cc-5(b)(1)(A)(vi).
- 376. Social Security Act § 1866E(b), 42 U.S.C. 1395cc-5(b).
- 377. Social Security Act § 1866E(f)(1), 42 U.S.C. 1395cc-5(f)(1).
- 378. Social Security Act §1866E(f)(2), 42 U.S.C. 1395cc-5(f)(2).
- 379. Social Security Act § 1866E(g), 42 U.S.C. 1395cc-5(g).
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