CMMI director: Home visits could be focus of upcoming Medicare demos

Before he became director of the Center for Medicare and Medicaid Innovation (CMMI), Adam Boehler founded Landmark Health, a provider group that gives chronically ill patients medical care in their homes—and foregoes the fee-for-service model, taking full financial risk.

“We never did what we did because somebody paid us per visit. We did whatever it made sense to do to take care of the patient,” Boehler told reporters at an event sponsored by the Alliance for Health Policy on Thursday. Landmark reduced hospital admissions among its patients by 40% and even decreased mortality, he said.

Now, Boehler may implement this work on another level. He said it’s “a possibility” that CMMI will create a home health bundled payment model, adding that the agency “will look at everything."

"If I can empower and give accountability to local participants, then they’re going to use what supports they have to derive the best outcomes for patients,” he said.

It can be difficult and costly for physicians to visit patients in their homes; Landmark paid its physicians nearly 50% above market, he explained. And many physicians prefer to make home visits.

“There are plenty of doctors that say, ‘I don’t want to be in an office … and I’d like to see really sick patients because I want to make a difference,’” he added.

However, the U.S. faces a growing shortage of both primary and specialty care physicians, including geriatricians. Boehler believes the non-physician healthcare workforce may be able to help fill this gap.

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While state licensing regulations may be a hurdle, nurse practitioners and physician assistants can help with the doctor shortage. Paramedics and social workers as professionals who could possibly step in as well.

“I think we have to recognize what we have,” he said.

It’s a unique idea for now, though perhaps not implausible. In Boehler’s words, this administration “is not overly sensitive to the status quo.”