Feb 28, 2012

Independence at Home, the Medical Home Model

New studies show that it can be less expensive to care for a person at home; rather than, in a traditional nursing home. The same studies indicate that this also leads to better medical outcomes. A large scale movement to keep the elderly at home is now gaining momentum.

By Bob DeMarco
Alzheimer's Reading Room

There is an excellent article in the New York Times that explains a new type of healthcare and new healthcare model -- A Shift From Nursing Homes to Managed Care at Home.

This new model would include a team of doctors, social workers, physical and occupational therapists, and other specialists, who together would provide managed care for individual patients at home, at adult day-care centers, and in visits to specialists.

I have been writing about this topic and advocating this for a long time. That said, I was surprised to learn that these new programs are starting to spread much faster than I understood.
The number of such programs has expanded rapidly, growing from 42 programs in 22 states in 2007 to 84 in 29 states today. -- Source, New York Times
At the same time, a study by the American Health Care Association indicates that the number of nursing homes has dropped by over 600 in the last six years.

I think most of us understand that the elderly want to stay at home, and out of nursing homes when possible.

I strongly suggest that you take the time to read the New York Times article.

You can also find additional information on Independence at Home, and the Medical Home Model below.

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The Independence at Home Demonstration, authorized by Section 3024 of the Affordable Care Act, will test a service delivery model that utilizes physician and nurse practitioner directed primary care teams to provide services to certain Medicare beneficiaries in their homes.

Under the Independence at Home Demonstration, the CMS Innovation Center will work with medical practices to test the effectiveness of delivering comprehensive primary care services at home and if doing so improves care for Medicare beneficiaries with multiple chronic conditions.

Additionally, the Demonstration will reward healthcare providers that provide high quality care while reducing costs.

Targeted Beneficiaries

The Demonstration will provide chronically ill Medicare beneficiaries a broader array of services
they can receive at home. Medicare beneficiaries who wish to participate must:
  • Have multiple chronic conditions
  • Be covered by original, fee-for-service Medicare
  • Require someone’s assistance with two or more activities of daily living such as bathing, dressing, eating or walking. Have had a medically-necessary hospital admission withinthe last 12 months
  • Have received rehabilitation services in the last 12 months

As many of you know, I have been writing about the benefits of keeping the deeply forgetful at home for years. I also alluded several times to the state programs that are already up and running like the one in Vermont.

You might be surprised to learn that the Medicare Medical Home Demonstration was authorized in 2007. This trial program was authorized by section Section 204 of the Tax Relief & Health Care Act of 2006. The Act mandated a demonstration in up to 8 states to provide targeted, accessible, continuous and coordinated care to Medicare beneficiaries with chronic or prolonged illnesses requiring regular medical monitoring, advising or treatment.

CMS also plans to test the patient-centered medical home model under the Innovation Center created by Section 3021 of the Patient Protection and Affordable Care Act, which provides CMS with an opportunity to test a variety of models and expand their implementation nationwide if they reduce spending without reducing quality or improve quality without increasing spending, and if the CMS Chief Actuary certifies that their expansion would be budget neutral, and if the Secretary determines that such an expansion would not result in denying or limiting coverage or the provision of benefits.

If I am reading the latest news from the White House on funding for Alzheimer's disease, then I believe I am correct in assuming there will be specific pilot programs within these demonstration programs directed at patients who suffer from Alzheimer's disease.

More Insight and Advice from the Alzheimer's Reading Room

Original content Bob DeMarco, the Alzheimer's Reading Room