Independence at Home Ina Li MD Independence at

Independence at Home Ina Li, MD Independence at Home Project Director Associate Director of Geriatrics at the Christiana Care Health System Medical Director of Christiana Care’s Visiting Nurse Association 1

Home Visit (HV) Paradigm 2

What is the purpose of IAH? Test a delivery model that uses primary care teams led by physicians and nurse practitioners to deliver timely, in-home primary care to Medicare patients with multiple chronic illnesses and functional impairments. Enroll 10, 000 Medicare Beneficiaries (Nationally). Christiana Care Health Services must enroll and maintain an average of 200 patients per project year (Year 1 - 6/1/12 to 5/31/13). 3

How long will the IAH Demonstration run? Start date is June 1, 2012 It will run for three years (June 1, 2012 – May 31, 2015) 4

What is the minimum number of patients and IAH practice must enroll per year? Each participating practice or consortium must provide services to a monthly average of at least 200 applicable patients during each year of the Demonstration. 5

What are the IAH eligibility requirements for patients? Entitled to Medicare benefits under Part A and B Not enrolled in a Medicare Advantage Plan Not enrolled in Program of All Inclusive Care for the Elderly (PACE) Have 2 or more chronic conditions Have 2 or more functional dependencies requiring the assistance of another person Have had a hospital admission within the past 12 months Have received acute or sub-acute rehab services within the past 12 months 6

IAH Payment Methodology CMS establishes an estimated target spending level If IAH practice expenditures are LESS THAN the estimated target spending level, then - CMS will retain 5% of the target spending level - 80/20 split between IAH practice and CMS. Incentive payments are subject to performance on quality measures 7

IAH Quality Measure Thresholds Quality Measures Threshold Value Number of inpatient admissions for ambulatory care sensitive conditions* Threshold equal to or less than the average utilization in an unmanaged, clinically similar population with case- mix and geographic adjustments. Number of readmissions within 30 days Number of ED visits for ambulatory sensitive conditions* Contact with patients within 48 hrs. 80% of the time upon admission to or discharge from the hospital or emergency department Medication Reconciliations in the home 80% of the time Patient preferences documented in the medical record 80% of the time * COPD, CHF, or diabetes 8

IAH Payment Methodology A practice that meets all of the SIX quality measures will receive 100% of the savings that qualify for sharing A practice that meets THREE of the six quality measures will receive 50% of savings that qualify for sharing 9

Home Visit (HV) Program Looked at data from between 3/28/2005 and 9/22/2011 There were 590 patents enrolled into the program 10 (HV) Patient average at HV admission is 80 73% of the HV patients are Female 64% are Caucasian; 32% are African American Predominant Referral Source: VNA and FMC practices 52% of HV patients exit the program through death The average duration a patient is in the HV program is 285 days

Results After entering the HV program, 30 day ED visits and inpatient admissions were both reduced. 11

HV and IAH Current Status Currently, our home visit practice has 285 patients 120 have qualified for the IAH program given the eligibility requirements Goal is to enroll another 100 -150 additional patients during Year 1 12

Patient Outreach Material “Are you having trouble getting out to see your doctor? ” “Have you been hospitalized in the past 12 months? ” “If so, then you may qualify for Christiana Care’s Independence at Home Program” The Independence at Home (IAH) Program is a home visit program sponsored by Medicare. If you qualify, you may receive primary care services at home from physicians, nurses, and social workers. Please call 302 -421 -2700 and ask for the “Independence at Home Program” to have the home visit team come see you. 13

Questions and Suggestions Next Steps Thank You! 14