On February 3, HHS Secretary Sebelius sent a letter to the Governors suggesting ways states might reduce their spending on Medicaid. http://www.hhs.gov/news/press/2011pres/01/20110203c.html The letter and its attachment notes that “five percent of [Medicaid] beneficiaries accounted for more than half of all Medicaid spending and one percent of beneficiaries accounted for 25 percent of all expenditures” and that 15% of “dual eligibles” account for 40% of all Medicaid spending. The letter further notes that most of these high cost beneficiaries suffer from chronic and disabling conditions. The letter further show that reducing the cost of this beneficiary population by just 10% “could save $15.7 billion in total Medicaid spending and produce a significant positive impact on longer term spending trends.”
The Independence at Home program was designed expressly to address the needs of the highest cost beneficiaries suffering from multiple chronic diseases and disabilities. The IAH home-based primary care model has been proven at hundreds of locations across the country for decades and has produced savings of 23% to 60% for this high cost patient population. This experience shows that the Independence at Home program could reduce Medicaid costs by more than $30 billion a year, based on HHS’ numbers.
The letter from Secretary Sebelius states that new service delivery models that focus on the high cost chronically ill population can be implemented without a waiver under the “Health Home” provision at section 2703 of PPACA that became effective January 1, 2011 and that the new Federal Coordinated Care Office is assisting the states to develop new models for serving the “dual eligibles”. Representatives of the American Academy of Home Care Physicians and staff from the offices of Congressman Ed Markey and Ron Wyden met on January 6 with personnel from the Federal Coordinated Care Office and showed how the Independence at Home program can be implemented by states under the “Health Home” provisions in section 2703. The Independence at Home program is the only program under the health reform legislation that (A) expressly targets the highest cost patient population, (B) provides primary care tailored to the patient’s individual needs in the home, (C) coordinates care across all treatment settings, (D) requires a minimum level of savings, outcomes and patient/caregiver satisfaction and (E) significantly reduces costs—not by cutting reimbursement or coverage—but by adding a new chronic care coordination benefit that better addresses the patient’s needs.
Several states are considering the Independence at Home program because it does not require any additional expenditures and is funded entirely from savings. Please let me know if you need more information about IAH as a Medicaid health home.
on behalf of the American Academy of Home Care Physicians and
The Independence at Home Coalition
POWERS PYLES SUTTER & VERVILLE PC
1501 M Street NW, Seventh Floor | Washington, DC 20005-1700
tel 202.466.6550 | fax 202.785.1756
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