In an effort to slow cost growth and improve health care quality, Medicare has in recent years developed a number of new ways to pay for and provide health care, and has been testing them through pilot programs in facilities and communities across the country. These test programs give heath care providers both financial incentives and new flexibility to change how they deliver care, with the goal of improving coordination and quality, reducing unnecessary or duplicative services, and focusing on outcomes important to patients and their families.
This report highlights and describes in detail seven innovative programs that represent a variety of approaches and span a wide range of Medicare services. In selecting these promising innovations, the authors examined the evidence of their effects on cost and quality-of-care. They also considered other implications, including effects on individuals’ access to care, and on patients’ and family caregivers’ experiences. The innovations are sorted into three groups based on evidence for their potential benefits.
In addition to describing these seven innovations, the report includes a discussion of each program’s results: its scope and scale, and its effects so far on cost and quality. The discussions review available evidence from Medicare as well as other government agencies and outside experts, covering specific dollar amount cost savings as well as quality measures, (e.g., hospitalizations, readmissions, emergency department visits), and other findings from patients and clinicians when available. The discussions consider potential benefits to consumers and to Medicare were any of these programs to be scaled up; they also identify potential negative effects and areas for potential improvement.
Transformation in health care takes time. However, with careful evaluation, development, and expansion of successful models, innovative Medicare payment and delivery models, like those reviewed here, have the potential to help control Medicare spending while improving the quality of care.
The seven innovations sorted into three groups based on evidence for potential benefits are as follows:
Group One: Innovations with demonstrated evidence of success that could yield broad benefits to both consumers and the Medicare program if expanded.
Innovation #1 – Independence at Home: Comprehensive In-Home Primary Care for People with High Needs
Independence at Home is testing whether providing comprehensive primary care services at home for individuals with very high health care needs leads to better health outcomes, improved patient and caregiver satisfaction, and lower Medicare costs. In theory, home-based care allows clinicians to provide coordinated, comprehensive care that reduces the risk for costly preventable hospital stays, readmissions, or emergency department visits.
Innovation #2 – Community-based Care Transitions Program: Partnerships between Community-Based Organizations and Hospitals to Improve Post-Hospital Transitions
The Affordable Care Act (ACA) mandated this program with the goal of reducing hospital readmissions, which are often caused by factors beyond the walls of the hospital (e.g., medication errors or not receiving sufficient assistance with activities of daily living). This initiative, now completed, relied heavily on community-based organizations with experience connecting patients and family caregivers to community support services (e.g., Meals on Wheels, transportation). Most of the