Bloom Health, Denver, Colorado.
Department of Family Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
JAMA Netw Open. 2024 Jul 1;7(7):e2421102. doi: 10.1001/jamanetworkopen.2024.21102.
The Centers for Medicare & Medicaid Services Innovation Center Independence at Home (IAH) demonstration, a test of home-based primary care operating in a value-based shared-savings payment model, ended December 2023 after a decade of consistently showing savings to Medicare. It is important to assess whether high-need, IAH-qualified beneficiaries continue to pose a growing challenge to traditional Medicare (TM) or if Medicare Advantage (MA), with programmatic features favorable to caring for this subset of the general Medicare population, can disproportionately provide such care.
To examine the size and share of IAH-qualified beneficiaries in TM and MA.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used all Medicare claims data and MA encounter data for 2014 and 2021. IAH qualifying criteria were applied to the TM populations enrolled in Parts A and B in 2014 and 2021, and to MA enrollees in 2021. Growth in the number of IAH-qualified TM beneficiaries from 2014 to 2021 was calculated, and the proportions and numbers of IAH-qualified enrollees in the total 2021 TM and MA populations were compared. Data were analyzed between April and June 2023.
The number and share of beneficiaries meeting IAH criteria in TM and MA; the share of TM spending among IAH-qualified beneficiaries.
Among 64 million Medicare beneficiaries in 2021, there were 30.55 million beneficiaries in TM with Parts A and B coverage, down from 33.82 million in 2014. The number of IAH-qualified beneficiaries in TM grew 51%, from 2.16 million to 3.27 million, while their proportionate share in TM grew 67% from 6.4% to 10.7% of TM between 2014 and 2021. IAH-qualified beneficiaries represented $155 billion in 2021 Medicare Parts A and B spending, 44% of all TM spending, up from 29% of total spending in 2014. In 2021, 2.15 million IAH-qualified beneficiaries represented 8.0% of Medicare Advantage enrollees. Combining TM and MA, 5.42 million IAH-qualified beneficiaries represented 9.3% of all Medicare beneficiaries, with 3.27 million (60.3%) being insured by TM.
In this cohort study of IAH-qualified Medicare beneficiaries, the share of IAH-qualified beneficiaries in TM grew between 2014 and 2021, with 60% of Medicare high-need beneficiaries accounting for 44% of TM spending. The Centers for Medicare & Medicaid Services should continue to operate value-based programs like IAH that are specifically designed for these high-needs individuals.
医疗保险和医疗补助服务创新中心独立在家（IAH）示范项目是一项基于家庭的初级保健测试，在基于价值的共享储蓄支付模式下运行，经过十年的持续节省医疗保险费用后，已于 2023 年 12 月结束。评估高需求、IAH 合格的受益人是否继续对传统医疗保险（TM）构成越来越大的挑战，或者医疗保险优势（MA）是否可以不成比例地提供此类护理，而医疗保险优势具有有利于照顾一般医疗保险人群中这一部分人群的计划特征，这一点很重要。
检查 IAH 合格受益人的规模和份额在 TM 和 MA 中的情况。
设计、设置和参与者：本队列研究使用了 2014 年和 2021 年的所有医疗保险索赔数据和 MA 遭遇数据。2014 年和 2021 年将 IAH 资格标准应用于 TM 人群中参加 A 部分和 B 部分的人群，2021 年将 IAH 资格标准应用于 MA 参保人。计算了 2014 年至 2021 年 IAH 合格 TM 受益人的数量增长，并比较了 2021 年 TM 和 MA 总人口中 IAH 合格参保人的比例和数量。数据于 2023 年 4 月至 6 月之间进行了分析。
在 TM 和 MA 中符合 IAH 标准的受益人的数量和比例；IAH 合格受益人的 TM 支出份额。
在 2021 年的 6400 万医疗保险受益人中，有 3055 万受益人参加了 TM 的 A 部分和 B 部分保险，低于 2014 年的 3382 万。TM 中 IAH 合格受益人的数量增长了 51%，从 216 万增加到 327 万，而他们在 TM 中的比例从 2014 年的 6.4%增长到 2021 年的 10.7%。IAH 合格受益人在 2021 年医疗保险 A 部分和 B 部分支出中占 1550 亿美元，占 TM 支出的 44%，高于 2014 年的 29%。在 2021 年，215 万 IAH 合格受益人占医疗保险优势参保人的 8.0%。将 TM 和 MA 合并，542 万 IAH 合格受益人占所有医疗保险受益人的 9.3%，其中 327 万（60.3%）由 TM 承保。
在这项关于 IAH 合格医疗保险受益人的队列研究中，2014 年至 2021 年间，TM 中 IAH 合格受益人的比例有所增长，60%的医疗保险高需求受益人的支出占 TM 支出的 44%。医疗保险和医疗补助服务中心应继续开展 IAH 等基于价值的项目，这些项目专门针对这些高需求人群。
