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What Is The Independence At Home Demonstration?

What is the Independence at Home Demonstration?

As the U.S. population ages, innovative programs will have to be developed to help seniors age in place. Just look at the numbers: there were forty million Baby Boomers over the age of 65 in 2011 and there will be 50 million by the year 2019. The oldest old, those aged 85+, numbered 3.5 million in 1994 and that is expected to double to 85 million by 2020. It will double again by 2040 as Baby Boomers hit that age. These numbers indicate the dire need for new approaches to senior care. One groundbreaking pilot program is a step in that direction.

The Centers for Medicare and Medicaid Services (CMS), and its CMS Innovation Center launched the Independence at Home Demonstration in 2012. It is an interesting and innovative approach to improving the health and wellness off seniors by delivering comprehensive primary care services at home. The Demonstration will test the effectiveness this approach and determine if it “improves care for Medicare beneficiaries with multiple chronic conditions”. The program will also reward health care providers that deliver high quality care while also reducing costs.

Fourteen single practices and one consortium are participating in the Demonstration which is now in its third year. Participating practices will make in-home visits tailored to an individual patient’s needs and coordinate their care. CMS will track the beneficiary’s care experience through quality measures.

Why home based care?

We know that home based care can improve physical, mental and emotional health. It improves quality of life and can increase a seniors’ overall sense of well-being. Care that is provided at home can ensure that seniors eat properly, adhere to medication guidelines and live in a safe environment that is appropriately adapted for their physical needs.

However, the home environment has always been a mystery for providers. The nagging question has always been, “What happens when the patient goes home? What factors interfere with appropriate compliance with the care plan?” The Demonstration seeks to answer some of those questions by using home based primary care to improve seniors’ health. For providers, home based care offers several very important benefits:

  • It allows health care providers to spend more time with patients.
  • Facilitates assessments performed in the home environment that take into account obstacles to care.

For those striving to improve quality of care and reduce costs:

  • At home primary care places greater accountability on providers for all aspects of the patient’s care.

The Demonstration project wants to discover if primary care at home can improve patient and caregiver satisfaction, lower healthcare costs and improve health that will reduce the need for hospitalization and other expensive types of care.

What are the results?

In the second performance year of the demonstration, 10,484 beneficiaries were enrolled in the 15 participating practices. According to CMS, 15 of the practices improved performance from the first year in at least two of the six quality measures set up by the demonstration. Four practices met the performance thresholds for all six quality measures.

In year three, practices must continue to improve their performance and meet quality thresholds for at least three of the six quality measures:

  • Follow up contact within 48 hours of a hospital admissions, hospital discharge, and emergency department visit.
  • Medication Reconciliation in the home within 48 hours of a hospital discharge and emergency department visit.
  • Annual documentation of patient preferences.
  • All-cause hospital readmissions within 30 days.
  • Hospital admissions for Ambulatory Care Sensitive Conditions.
  • Emergency department visits for Ambulatory Care Sensitive Conditions.

We applaud CMS for launching this innovative approach to senior care. The current system of healthcare must change to meet the burgeoning demands of a rapidly expanding senior population. In-home caregivers are just one type of support that can improve the health and well-being of seniors. The medical community is needed in the home as well, but the current healthcare system doesn’t provide them with the flexibility or reimbursement models necessary to make that possible. The Independence at Home Demonstration is a very important step forward in that regard.


If you need help caring for your loved one, contact Family Matters In-Home Care for a free consultation. Our caregivers will spend time with your loved one, provide companionship, activities that are mentally stimulating, and will cook nutrition meals and do light housekeeping. Most importantly, our caregivers will give you peace of mind that your loved one is being cared for with the proper support.