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Independence at Home Act

What's at Stake?
Individuals with multiple, chronic conditions have higher health care costs and often see many providers, take numerous medications, and receive services in multiple settings. Such disjointed care drives up health care costs, causes medication errors, and triggers unnecessary hospitalizations. For example, 20 percent of Medicare beneficiaries have five or more chronic conditions, and those people account for two-thirds of all Medicare spending. To reduce expenses and to improve quality, we must do a better job of coordinating the care provided to people with multiple, chronic conditions—across providers and settings. We must also create a health information-technology network to support such care and to provide support for family caregivers who coordinate care.

Some Medicare beneficiaries receive chronic-care management or coordination through certain types of Medicare Advantage plans. However, for the vast majority of Medicare beneficiaries, who choose to receive their care in the traditional program, there is no formal assessment of their overall care needs or care coordination. AARP wants to ensure that beneficiaries have access to chronic-care services, regardless of their coverage options.

Legislative Summary
The Independence at Home Act (S. 3613/H.R. 7114), sponsored by Sen. Ron Wyden (D-Ore.) and Reps. Edward Markey (D-Mass.) and Chris Smith (R-N.J.), would establish a large demonstration program to provide assessments and chronic-care coordination services to eligible Medicare beneficiaries on a voluntary basis. The program targets those Medicare beneficiaries with multiple, chronic conditions, who have higher health costs, see more health care providers, and have a greater need for coordination of their care.

The bill also recognizes the role of family caregivers, would (as appropriate) provide education and counseling, and would connect the caregivers to additional support. The legislation requires minimum performance standards, including patient, caregiver, and provider satisfaction; and a required minimum savings of 5 percent annually. Provided the mandatory savings requirement is met, it could be used to help pay for other much-needed improvements to Medicare.

AARP Position
AARP endorses the Independence at Home Act. It would bring chronic-care coordination services to traditional Medicare, which would not only save money but would also improve the quality of health care for those who need it most.

According to the U.S. Centers for Disease Control and Prevention, the problem of chronic diseases, such as cardiovascular diseases and diabetes, must be addressed if we are to tackle escalating health care costs. AARP believes it is critical that the Medicare program use its leverage to lead change in the health care system.

The Independence at Home Act is an important building block for health care reform. It also aligns with AARP efforts to help people remain independent in their homes, to improve care coordination for those with multiple chronic conditions, and to support family caregivers.

AARP is actively engaged in building support for chronic-care coordination. To date, its efforts to promote passage of this bill have included sending letters of support to bill sponsors, educating Capitol Hill staff on the benefits of the legislation, and featuring articles in AARP publications.

Legislative Timeline
The Independence at Home Act was introduced in the U.S. House and Senate on Sept. 26, 2008. The bill did not see action in 2008, but it will be reintroduced in 2009, and it could be included in prospective health care or Medicare reform or in other legislation.

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