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Evaluation of Year 9 (2022) - Key Takeaways:
Independence at Home (IAH) was a Congressionally mandated demonstration project testing whether a payment incentive for home-based primary care reduces health care spending and improves the quality of care for high-cost, high-need fee-for-service Medicare beneficiaries. Participating home-based primary care practices could earn incentive payments if their beneficiaries’ Medicare spending was less than a spending target and they met standards for a set of quality measures.
- In Year 9, the number of participating clinicians and eligible beneficiaries in IAH declined for the fourth consecutive year.
- IAH may have reduced gross total Medicare spending during Year 9, but likely not net of IAH incentive payments.
- The effect on spending in Year 9 was concentrated among beneficiaries dually eligible for Medicare and Medicaid, as in Year 8.
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The Two Page Overview:
The Report (includes an Executive Summary):
Additional Supporting Materials:
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Final Evaluation Report (2018-2024) - Key Takeaways:
The Medicare Diabetes Prevention Program (MDPP) is an evidence-based, yearlong lifestyle change program with the goal of preventing or delaying type 2 diabetes in individuals with prediabetes. The program aims to help individuals lose at least 5% of their weight, with the goals of improving patient health and lowering Medicare expenditures. The program provides education in long-term dietary change, increased physical activity, and behavior change strategies for weight control.
The average weight loss of MDPP beneficiaries was 4.9%. Average weight loss was highly correlated with the numbers of sessions attended. More than half of beneficiaries (53%) met the 5% weight loss goal. Of those who lost at least 5% of body weight and stayed in the program, 80% maintained at least 5% weight loss.
MDPP introduced a new class of providers to Medicare, which expanded the delivery of diabetes prevention services into both clinical and nonclinical community settings. MDPP’s high retention rates and association with weight loss is promising, however, reach of the program has been limited. Although an estimated 16 million Americans 65 years of age or older are eligible for MDPP, fewer than 10,000 beneficiaries have participated in MDPP. Limited participation among suppliers and beneficiaries has kept MDPP from having an overall impact on population health.
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The Two Page Overview:
The Report (includes an Executive Summary):
Additional Supporting Materials:
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Evaluation of Medicare Advantage VBID Model Test (2020-2023) - Key Takeaways:
VBID General Component, 2020–2023
The Value-Based Insurance Design (VBID) model test enables Medicare Advantage (MA) insurers to offer one or more benefit flexibilities, such as reduced cost-sharing or additional supplemental benefits, in participating plans. Most VBID benefits can be targeted based on beneficiaries’ chronic conditions or socioeconomic status (SES), which is defined based on eligibility for the Part D Low-Income Subsidy (LIS) or dual eligibility for Medicare and Medicaid where LIS is not available. The model tested whether VBID benefit flexibilities could support patient-centered care and price transparency, increase enrollee choice and access to timely and clinically appropriate care, improve quality, and reduce costs.
- Between 2020 and 2023, model participation grew, especially among Dual Eligible Special Needs Plans (DSNPs). In 2023, the most implemented intervention was Part D reduced cost-sharing, followed by supplemental benefits.
- Implementation continues to be relatively easy, but data reporting and vendor relationships remain challenging. Implementation experiences vary by intervention type; supplemental benefits administered with restricted-use debit cards are the most burdensome.
- VBID General was associated with increases in (1) beneficiary adherence, risk scores, and inpatient stays in 2020 and 2021 and (2) Star Ratings and costs to CMS in 2021 and 2022. In 2022, the model was also associated with reduced Part D out-of-pocket costs for targeted beneficiaries.
VBID Hospice Component, 2021–2023
From 2021 through 2024, the voluntary Medicare Advantage (MA) Value-Based Insurance Design (VBID) model allowed MA insurers to offer the Medicare Hospice Benefit within their plans. Outside VBID, hospice care is not included in MA plan benefit packages and is paid through traditional Medicare. The Hospice Benefit component consolidated responsibility and accountability for the cost, quality, and outcomes of MA beneficiaries in hospice with the intent of promoting care coordination and improving quality of care while maintaining budget neutrality or reducing costs.
- Plan participation in the Hospice Benefit component grew between 2021 and 2023, but uptake of palliative care, transitional concurrent care, and hospice supplemental benefits was low in all years.
- Most insurers and in-network hospices continuing their participation in the model in 2023 indicated that implementation was manageable because beneficiary volume was low.
- The proportion of beneficiaries receiving care from in-network hospices grew, rising to more than half of beneficiaries starting hospice in 2023. In-network hospices were larger and more often chains than out-of-network hospices.
- The Hospice Benefit component was: 1) not associated with changes in levels of hospice enrollment in 2021 or 2022, and 2) associated with reductions in combined MA and Part D bids in 2021 and 2022 but not in 2023.
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The Two Page Overview:
The Report:
Additional Supporting Materials:
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