1. How the Independence at Home Demonstration is Good for Home Care HCA Conference Call January 12, 2012

2. The Basics Authorized by Section 3024 of the Affordable Care Act. Authorized by Section 3024 of the Affordable Care Act. Tests a payment incentive and service delivery model that uses home-based primary care for Medicare FFS beneficiaries with multiple chronic illnesses. Tests a payment incentive and service delivery model that uses home-based primary care for Medicare FFS beneficiaries with multiple chronic illnesses. The Demo will assess the effects of timely, in-home primary care on health costs, quality of care, and rates of preventable hospitalizations, hospital readmissions and ED visits The Demo will assess the effects of timely, in-home primary care on health costs, quality of care, and rates of preventable hospitalizations, hospital readmissions and ED visits Deadline for application: February 6 th, 2012 Deadline for application: February 6 th, 2012

3. Can any physician practice participate? No…a practice must have: No…a practice must have: Have at least an average of 200 applicable beneficiaries. Have at least an average of 200 applicable beneficiaries. 24/7 availability to carry out plans of care. 24/7 availability to carry out plans of care. Electronic Health Information Systems. Electronic Health Information Systems. Remote patient monitoring. Remote patient monitoring. Mobile diagnostic technology. Mobile diagnostic technology.

4. IAH Medicare Beneficiaries… Must be entitled to Part A and enrolled in Part B Must be entitled to Part A and enrolled in Part B NOT enrolled in a Medicare Advantage plan or PACE Program NOT enrolled in a Medicare Advantage plan or PACE Program Cannot be enrolled in a practice that is part of a Medicare Shared Savings Program Cannot be enrolled in a practice that is part of a Medicare Shared Savings Program

5. Applicable Beneficiaries… At least two chronic illnesses At least two chronic illnesses Must need assistance with two or more ADL’s Must need assistance with two or more ADL’s Has had a non-elective hospital admission in the last 12 months and has used acute or sub-acute rehab services in the last 12 months Has had a non-elective hospital admission in the last 12 months and has used acute or sub-acute rehab services in the last 12 months

6. Quality Measures Assess patient utilization (re-hospitalization rate, ED visit rate) Assess patient utilization (re-hospitalization rate, ED visit rate) Indicate aspects of health status (pain control, depression screening) Indicate aspects of health status (pain control, depression screening) Highlight processes of care (contact with beneficiaries within 48 hrs of hospital admission/discharge, in-home safety assessments). Highlight processes of care (contact with beneficiaries within 48 hrs of hospital admission/discharge, in-home safety assessments). Some quality measures tied to incentive payments – some tied to performance monitoring. Some quality measures tied to incentive payments – some tied to performance monitoring.

7. Quality Measures - continued

8. IAH Spending CMS will establish practice specific spending target. CMS will establish practice specific spending target. The spending target for each practice will be risk adjusted and frailty adjusted to reflect each practice’s patient population using the following formula: The spending target for each practice will be risk adjusted and frailty adjusted to reflect each practice’s patient population using the following formula: Average FFS Cost in County of Residence *Trend* (Risk adjusted score + frailty factor)

9. IAH Savings Savings will be calculated as the difference between each practice’s spending target and actual FFS costs Savings will be calculated as the difference between each practice’s spending target and actual FFS costs Each participating practice must meet a Minimum Savings Requirement (MSR) to be eligible to share in savings. Each participating practice must meet a Minimum Savings Requirement (MSR) to be eligible to share in savings.

10. Opportunity for Home Care MD’s will be in a person’s HOME environment identifying unmet needs that will help people remain independent. MD’s will be in a person’s HOME environment identifying unmet needs that will help people remain independent. Closer alignment and communication between physician practice and home care. Closer alignment and communication between physician practice and home care. Practices must be available 24/7, have remote monitoring, and EMR. Practices must be available 24/7, have remote monitoring, and EMR. Easier Face-to-Face? Easier Face-to-Face?

11. Opportunity for Home Care Quality Measures: Quality Measures: Focus on care transition activities Focus on care transition activities Aspects of health status Aspects of health status Process of care Process of care Performance Monitoring: Caregiver stress, patient satisfaction, voluntary disenrollment rate, medication management/reconciliation, symptom management, screenings/assessments, patient preferences, caregiver/beneficiary goals. Performance Monitoring: Caregiver stress, patient satisfaction, voluntary disenrollment rate, medication management/reconciliation, symptom management, screenings/assessments, patient preferences, caregiver/beneficiary goals.

12. MORE INFO CMS Independence At Home Demo webpage. CMS Independence At Home Demo webpage. CMS Independence At Home Demo webpage. CMS Independence At Home Demo webpage. Contact Us! Contact Us! jfuccione@thinkhomecare.org jfuccione@thinkhomecare.org jfuccione@thinkhomecare.org 617-482-8830 617-482-8830