Home Is Where Your Health Is: 5 Thoughts From The IAH Demonstration

By Tom Schramski, PhD, CMAA

Volume 2 Issue 13, June 23, 2015

tt152-d7a81d1e-c1b7-480b-9c51-8c293fc5e3dd-v2Last week, the Centers for Medicare and Medicaid Services (CMS), released first-year results from the Independence At Home (IAH) Demonstration, which focuses on providing primary healthcare services to qualified individuals (65 years of age or older) with multiple medical conditions and impairments.  These individuals, many of whom are very high utilizers of healthcare resources, have been prioritized in an effort to provide high quality, cost-effective healthcare in the era of the Affordable Care Act.

The results, in some cases, have been remarkable.  In Portland, Housecall Providers, one of 17 national IAH participants, showed a 32% savings for home-based primary care compared to the control group, which received no home-based primary care.  In fairness, not all IAH participants evidenced the same positive impact, but others showed even more.  Many patients remarked positively on the nature of their care and Housecall Partners received a Practice Incentive Payment of $1,228,263, in addition to their other fees, from CMS.  CMS (our government) kept an equal amount of the savings.

These results point to a future that includes the following:

  • Similar pilot projects will be launched in other areas of healthcare with financial incentives and there will be increased marketplace interest.  It’s a win-win: publicly funded healthcare becomes more affordable while entrepreneurial healthcare providers fulfill their mission and build market share and intelligence.
  • Traditional thinking that expensive, specialist-oriented interventions are necessary for all complex medical issues will continue to wane.  Housecall Providers indicates that their typical elderly patient is one with Alzheimer’s and chronic pulmonary disease, often with other complications.
  • With the relative decline in primary care physicians, there will be more opportunities for Physician Assistants, skilled nurses, and similarly-trained individuals who can deliver competent services in a home setting.
  • Allied technologies, including telehealth, will receive further impetus to expand and supplement more personalized primary care, while elderly citizens will be encouraged to increasingly utilize technology, like tablets, to improve accessibility and life quality.
  • Greater attention will be given to the social support element of healthcare (e.g. patient-chosen home) as critical to effective healthcare service.

In the Epilogue to his very insightful book, Being Mortal, Atul Gawande wrote:

We’ve been wrong about what our job is in medicine.

                           We think our job is to ensure health and survival.

                           But really it’s larger than that.  It is to enable well-

                           being.  And well-being is about the reasons one 

                           wants to live.

The personal and economic truth of his words can be seen in all areas of healthcare, from the urgent care and CVS-type retailing of health and wellness to the emerging social support movement, including adequate housing, for individuals with serious mental illness.  Customers want it, funders want it, and so do physicians and other care providers.  This is where we are headed – a positive Pandora’s Box – and it offers abundant opportunity for the healthcare entrepreneur.