The Independence At Home Demonstration

This article describes the challenges of a shared-savings model for high-need, high-risk Medicare beneficiaries, exemplified by the Independence at Home (IAH) demonstration. It suggests ways that the Centers for Medicare & Medicaid Services (CMS) could improve its risk-adjustment methodology for the IAH model. IAH's success, with CMS reporting more than $100 million in savings during its first five years, seven of fourteen practices receiving shared savings, and thirteen of fourteen practices meeting cost benchmarks, shows that such a model for small practices is useful for policy makers.