Guest Post: How Innovations in Care Delivery Improve Quality & Cut Costs

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This article was contributed by CMS’ Center for Medicare & Medicaid Innovation. 

At the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare & Medicaid Innovation (Innovation Center) we support the development and testing of innovative health care payment and service delivery models. Since 2012, we have tested a variety of ways to improve patient care and lower health care costs. As part of this work, we are committed to delivering high quality care to Medicare beneficiaries with multiple chronic conditions, and we have tested several patient-centered models that support providers in the delivery of comprehensive primary care in homes. 

In 2012, we began the Independence at Home (IAH) Demonstration, which was created under federal law to explore whether home-based care can reduce the need for hospitalization, improve patient and caregiver satisfaction, lead to better health for beneficiaries, and lower Medicare costs.

Currently, there are 14 sites — 13 primary care practices and one consortium — in IAH. In its first two years, the demonstration saved Medicare more than $32 million, or an average of $1,010 per beneficiary, and provided high-quality primary care services for chronically ill beneficiaries. 

Medicare beneficiaries participating in IAH practices, on average, have fewer hospital readmissions within 30 days and use inpatient hospital and emergency department services less often for conditions such as diabetes, high blood pressure, asthma, pneumonia and urinary tract infections. In addition, participants are more likely to have follow-up contact from their provider within 48 hours of a hospital admission, hospital discharge or emergency department visit; medications identified by their provider within 48 hours of discharge from the hospital; and their preferences documented by their provider. 

The demonstration saved Medicare more than $32 million, or an average of $1,010 per beneficiary

In addition to IAH, from 2012 to 2016, the CMS Innovation Center tested the Comprehensive Primary Care Initiative in 500 practices located in seven regions throughout the U.S., leveraging multi-payer support to strengthen primary care. In 2017, we continued this effort by implementing the Comprehensive Primary Care Plus (CPC+) initiative, an advanced primary care model designed to improve access to primary care at lower cost, particularly for patients with complex needs. Currently there are 2,932 primary care practices participating in the model, as well as 61 aligned private and state payers in 18 regions. 

In CPC+, practices have the flexibility to deliver care based on patient needs and preferences, as opposed to care being guided by billing and coding requirements. In fact, as of July 2018, more than one-third of CPC+ practices reported that they chose to deliver care in the home of elderly patients. This service engages patients in the management of their own care and better coordinates care for our most vulnerable homebound beneficiaries. While CPC+ is still in its early stages, we are excited to support primary care practices through this initiative and look forward to assessing its impact on costs and quality.

Both models are key components of the administration’s broader strategy to improve the health care system by paying practitioners for what works, unlocking health care data, as well as finding new ways to coordinate and integrate care to improve quality.