1. Jim Pyles, Principal Powers, Pyles, Sutter & Verville, P.C. 1501 M Street, NW, Washington, D.C. 20005 (202) 466-6550 jim.pyles@ppsv.com ©AAHCM No Financial Disclosures

2. Independence At Home A. Unsustainable Costs B. Aging Population C. Rise of Chronic Illness H. Practitioner Autonomy G. Approval of ACA E. Patient/Caregiver Popularity D. SGR Fix F.Care for under served ©AAHCM

3. Bipartisan Agreement The “single greatest fiscal challenge” facing the U.S. today is the high and unsustainable cost of health care. “The Moment of Truth,” Bipartisan Deficit Reduction Commission “nothing else even comes close.” President Barack Obama ©AAHCM

4.  Out of 971 provisions in the Affordable Care Act, how many require any level of savings? ONE! The Independence at Home program (at section 3024) which requires minimum savings of 5% on the highest cost Medicare beneficiaries as a condition of participating ©AAHCM

5.  Beginning in 2014, Medicaid enrollment will increase by 19.6 million people  Private insurance enrollment will increase by 12.3 million (Cong. Budget Office)  Medicare, Medicaid and private insurance will be required to cover “preventive care” with no deductibles or copayments. Those services must include screening for certain chronic diseases  Insurers will have to cover “essential benefits” which include chronic disease management and mental health parity ©AAHCM

6.  Medicare population will grow by over 70% in next 20 years  More than 2/3’s of Medicare population have 2+ chronic conditions—percentage and number of those beneficiaries will increase  14% of beneficiaries with 6+ chronic conditions account for 46% of costs. MedPAC Report, pp. 19-22 (March 2014)  CBO policy alternative—”identify the relatively small group of potentially high-cost beneficiaries and find effective intervention strategies to reduce their spending... even a small percentage reduction in the spending of that group of beneficiaries could lead to large savings for the Medicare program.” High-Cost Medicare Beneficiaries, CBO, p. 1 (May 2005) ©AAHCM

7.  Takes primary care to highest cost beneficiaries in their homes  Coordinates care across all treatment settings  Focuses on highest cost beneficiaries with multiple chronic conditions who account for large percentage of Medicare’s costs  Requires minimum annual savings of 5% as a condition of participation—only successful programs may participate ©AAHCM

8.  Beneficiary enrollment is voluntary (no assignment)  Beneficiaries not required to give up their doctor or any benefit  Funded by savings  Reduces fraud incentive  Broad bipartisan Congressional support  Provides a new service that beneficiaries and families want  Provides reinvestment capital for training and technology to achieve future savings  You “get what you pay for” ©AAHCM

9. Most importantly: The IAH Model WORKS! ©AAHCM

10.  10,000 beneficiary target exceeded in year one  18 programs selected—16 states and D.C. ◦ 2 consortia ◦ 16 individual sites  Targeted high cost patients enrolled ◦ HCC 3.4 ◦ First year analysis imminent ◦ Single sites June 2012-June 2013 ◦ Consortia Sept 2012 – Sept 2013  Grant funded learning collaborative ensures adoption of best practices ©AAHCM

11.  Beginning January 1, 2011 and continuing for nineteen years, 10,000 Americans will turn 65 each day Pew Research and Social Trends (Dec. 20, 2010)  Americans are living longer (an average of 78.5 years) and sicker with more chronic diseases such as cardiovascular disease, hypertension, diabetes and Alzheimer’s Disease “Health Rankings: USA Living Longer, But Sicker,” USA Today (Dec. 11, 2012) ©AAHCM

12. Staff for Senator Richard Burr (R-NC) Independence at Home is “targeted, immediate, and proven.” Senator Ron Wyden “The Independence at Home health care delivery model coupled with technology is the future of health care.” ©AAHCM