Falling behind: The growth of frail, high‐need beneficiaries receiving home based primary care in traditional Medicare 2014–2021

Home-based primary care (HBPC) is an important service for complex, high-need patients that has been shown to improve health outcomes while significantly lowering the total cost of care.1 As a result of the HBPC care model, which includes an interdisciplinary team, proactive outreach, and high visit frequency, the recipients of HBPC are less likely to be hospitalized and spend more total days at home, than similar patients who do not receive HBPC. These findings have recently been reconfirmed with the release of results from Year 2 of the High Needs Direct Contracting (HN-DC) model.2 As the population ages, HBPC will be an important tool for controlling healthcare costs and providing healthcare access.In the present study, we investigate growth in the share of the high-need population that can benefit from HBPC and whether there has been corresponding growth in receipt of HBPC. We use the eligibility criteria for Medicare's Independence at Home (IAH) demonstration, which are effective at identifying a high-need, high-cost population that is eligible for HBPC.3 At IAH inception in 2012, IAH-qualifying (IAHQ) individuals comprised less than 6% of traditional Medicare (TM) beneficiaries, yet accounted for 29% of TM spending.4 In 2021, they constituted 11% of TM beneficiaries and accounted for 44% of TM spending.