A Family Member HomeCare, a Hallandale, Hollywood and Miramar Home Health Care Agency, Notes Affordable Care Act's Independence At Home Project Could Help Broaden Home-Based Care Services


U.S. News and World Report: Health Reform Testing Home-Based Care

August 17, 2012

By Phil Moeller, U.S. News and World Report "The Best Life" Blog

The health reform spotlight usually focuses on the 2014 requirement that most people buy health insurance, the creation of new state health insurance exchanges, and whether states will participate in the law's big increase in Medicaid services. But under the radar, the law has also triggered a flurry of new programs searching for better and cheaper ways to provide healthcare.

One of them, the Independence at Home (IAH) demonstration project, could have a huge impact on seniors with chronic illnesses. With growing numbers of older Americans, many of whom will post impressive longevity gains, rising healthcare costs are a national and personal problem. If the IAH test is successful, it would point the way toward lowering costs and also boost the broader provision of home-based healthcare services, thus helping seniors age in place in their homes and avoid institutionalized care.

The project, overseen by the government's Center for Medicare and Medicaid Innovation (CMMI), has recently finished enrolling 19 medical practice groups throughout the country. Over the next three years, these groups expect to provide in-home care to about 10,000 people with multiple chronic health conditions. A detailed study by Medicare of 2008 treatments and expenses found that more than 90 percent of its expenses were to treat people with multiple chronic conditions.

Treating seriously ill Medicare beneficiaries is enormously expensive, in part due to the high expenses of repeated hospital stays and related care and drug expenses. According to Medicare records, the five most common chronic conditions in 2008 were hypertension (affecting 56 percent of all beneficiaries), high cholesterol (43 percent), heart disease (32 percent), diabetes (27 percent), and arthritis (21 percent).

These figures include disabled beneficiaries, many of whom are younger than 65. The percentages of people age 65 and older with these chronic conditions is even higher. About a third of all beneficiaries have two or three chronic conditions, and another third have more than three. While only about 12 percent of Medicare recipients had six or more chronic conditions, they accounted for 40 percent of Medicare's expenses.

The 19 practices chosen for the IAH demonstration already have experience providing home care to chronically ill Medicare patients. They were also selected to reflect different parts of the country, including rural and urban practices. To qualify for the program, patients must:

• Have two or more chronic conditions

• Have coverage from original, fee-for-service (FFS) Medicare

• Need assistance with two or more functional dependencies (walking, feeding, dressing and other activities of daily living)

• Have had a non-elective hospital admission within the last 12 months

• Have received acute or subacute rehabilitation services in the last 12 months

Even with these restrictions, an estimated 1.4 million Medicare beneficiaries would qualify if the program was offered in all markets in the country.

"Many of these people have difficulty getting out of their home and getting to their doctor's office," says Rick Gilfillan, CMMI director. The goals of the IAH test are to see if in-home care can improve the health of participants, provide a more satisfactory care experience, and save money, he explains. Over time, practices that achieve all of these goals would be able to keep some of the money saved through reduced care expenses.

As an example of how at-home care would work, care professionals would go into the patient's home and look at the medications they are taking. Often, people are prescribed additional medication when they are discharged from a hospital but either don't fill these new prescriptions or even understand them. At-home care providers would check to see that prescriptions have been filled and that patients are taking the right drugs in the proper doses.

The demonstration period is three years. But Gilfillan says the CMMI doesn't need to wait that long to set up additional tests. It has the authority, for example, to create additional demonstrations of approaches by some IAH practices that have produced very positive early results.

Twitter: @PhilMoeller




A FAMILY MEMBER HOMECARE — Approved by the Joint Commission on Accreditation of Healthcare Organizations. A Broward, Miami-Dade and Palm Beach County Home Health Care Agency Serving Coconut Creek, Cooper City, Coral Springs, Dania, Davie, Deerfield, Ft. Lauderdale, Hallandale, Hillsboro, Hollywood, Lauderdale Lakes, Lauderdale-by-the-Sea, Lauderhill, Lighthouse Point, Margate, Miramar, North Lauderdale, Oakland Park, Parkland, Pembroke Park, Pembroke Pines, Plantation, Pompano, Sea Ranch Lakes, Southwest Ranches, Sunrise, Tamarac, Weston, Wilton Manors, Aventura, Hialeah, North Miami, Miami Lakes, Sunny Isles, Bal Harbour, Surfside, Boynton, Boca Raton, Lake Worth & Delray Beach With Comprehensive Home Health Care Services, In-Home Caregivers, Nursing & Home Health Aides for Seniors, Elderly, Disabled, Dementia & Alzheimer’s Patients. Licensed, Bonded, Insured

A Family Member HomeCare, a Ft. Lauderdale, Broward Florida Home Health Care Agency Notes: Medicare prescription drug premiums to remain steady for third straight year


Average basic premiums for Medicare prescription drug plans are projected to remain constant in 2013, Health and Human Services Secretary (HHS) Kathleen Sebelius announced on August 6, 2012.  The average 2013 monthly premium for basic prescription drug coverage is expected to be $30. Average premiums for 2012 were projected to be $30 and ultimately averaged $29.67. At the same time, since the law was enacted, seniors and people with disabilities have saved $3.9 billion on prescription drugs as the Affordable Care Act began closing the “donut hole” coverage gap.
“Premiums are holding steady and, thanks to the health care law, millions of people with Medicare are saving an average of over $600 each year on their prescription drugs,” said Secretary Sebelius. 
Today’s projection for the average premium for 2013 is based on bids submitted by drug and health plans for basic coverage during the 2013 benefit year, and calculated by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. 
The upcoming annual enrollment period -- which begins Oct. 15 and ends Dec. 7, 2012 – allows people with Medicare, their families and their caregivers to choose their plans for next year by comparing their current coverage and quality ratings to other plan offerings. New benefit choices are effective Jan. 1, 2013.
Because of the Affordable Care Act, out-of-pocket savings on medications for people with Medicare continue to grow.  Last month, CMS announced that more than 5.2 million people with Medicare have saved over $3.9 billion on prescription drugs in the Medicare Part D donut hole since the law was enacted.  In the first half of 2012, over 1 million people with Medicare saved a total of $687 million on prescription drugs, averaging $629 per person this year.
As a result of the Affordable Care Act, coverage for both brand name and generic drugs in the coverage gap will continue to increase over time until 2020, when the coverage gap will be fully closed.  This year, people with Medicare received a 50 percent discount on covered brand name drugs and 14 percent coverage of generic drugs in the donut hole. In 2013, Medicare Part D’s coverage of brand name drugs will begin to increase, meaning that people with Medicare will receive a total of 52.5 percent off the cost of brand name drugs (a 50 percent discount and an additional 2.5 percent in coverage) and coverage for 21 percent of the cost of generic drugs in the donut hole.
For more information on how the Affordable Care Act closes the Medicare drug benefit donut hole, please visit:http://www.healthcare.gov/law/features/65-older/drug-discounts/index.html.

A FAMILY MEMBER HOMECARE — Approved by the Joint Commission on Accreditation of Healthcare Organizations. A Broward, Miami-Dade and Palm Beach County Home Health Care Agency Serving Coconut Creek, Cooper City, Coral Springs, Dania, Davie, Deerfield, Ft. Lauderdale, Hallandale, Hillsboro, Hollywood, Lauderdale Lakes, Lauderdale-by-the-Sea, Lauderhill, Lighthouse Point, Margate, Miramar, North Lauderdale, Oakland Park, Parkland, Pembroke Park, Pembroke Pines, Plantation, Pompano, Sea Ranch Lakes, Southwest Ranches, Sunrise, Tamarac, Weston, Wilton Manors, Aventura, Hialeah, North Miami, Miami Lakes, Sunny Isles, Bal Harbour, Surfside, Boynton, Boca Raton, Lake Worth & Delray Beach With Comprehensive Home Health Care Services, In-Home Caregivers, Nursing & Home Health Aides for Seniors, Elderly, Disabled, Dementia & Alzheimer’s Patients. Licensed, Bonded, Insured

A Family Member HomeCare, a Miramar, Pembroke Pines Home Health Care Agency Advises U.S. Department of Health and Human Services (HHS) partners with pharmacies to educate Medicare beneficiaries about new health benefits


HHS partners with pharmacies to educate Medicare beneficiaries about new health benefits

On August 15, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius announced partnerships with several pharmacies to help customers learn about new Medicare benefits available to them under the Affordable Care Act – the health care law.  These partnerships – with CVS Caremark, Walgreens, Thrifty White, Walmart, and Sam’s Club – will provide Medicare beneficiaries a range of educational materials on newly available preventive services, as well as savings on prescription drug spending in the “donut hole” coverage gap.  At a CVS in Jacksonville, Secretary Sebelius discussed the new preventive services and received a free blood pressure reading at the CVS MinuteClinic.
“Our pharmacy partners are helping their customers make informed health care decisions,” said Secretary Sebelius.  “These partnerships will help people with Medicare learn more about new preventive services such as mammograms, and the new Annual Wellness visit that are available at no charge for everyone with Medicare.”
Some examples of how pharmacy partners are working to increase awareness of preventive services available under Medicare include the following:
  • CVS Caremark is distributing material about new preventive services covered at no cost to beneficiaries at its more than 7,300 CVS/pharmacy stores and 600 MinuteClinic locations, through brochures, register receipt messages and online.
  • Thrifty White Pharmacy is providing information on preventive services through its 85 locations throughout the Midwest.
  • Walgreens is distributing information in nearly 8,000 pharmacies and over 350 Take Care Clinic locations, as well as using in-store announcements and providing this information as part of its Walgreens Way to Well Health Tour with AARP.
  • HHS is working with Walmart and Sam’s Club to provide healthcare information to their shoppers online. 
Other pharmacies or partners can find information on how to work with CMS to educate consumers about the benefits available to them at: http://www.cms.gov/Outreach-and-Education/Outreach/Current-Partnership-Opportunities/index.html
To learn more about Medicare, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. This announcement is available on the CMS web site at: http://www.cms.gov/apps/media/press_releases.asp.

A FAMILY MEMBER HOMECARE — Approved by the Joint Commission on Accreditation of Healthcare Organizations. A Broward, Miami-Dade and Palm Beach County Home Health Care Agency Serving Coconut Creek, Cooper City, Coral Springs, Dania, Davie, Deerfield, Ft. Lauderdale, Hallandale, Hillsboro, Hollywood, Lauderdale Lakes, Lauderdale-by-the-Sea, Lauderhill, Lighthouse Point, Margate, Miramar, North Lauderdale, Oakland Park, Parkland, Pembroke Park, Pembroke Pines, Plantation, Pompano, Sea Ranch Lakes, Southwest Ranches, Sunrise, Tamarac, Weston, Wilton Manors, Aventura, Hialeah, North Miami, Miami Lakes, Sunny Isles, Bal Harbour, Surfside, Boynton, Boca Raton, Lake Worth & Delray Beach With Comprehensive Home Health Care Services, In-Home Caregivers, Nursing & Home Health Aides for Seniors, Elderly, Disabled, Dementia & Alzheimer’s Patients. Licensed, Bonded, Insured