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News Roundup: October 30, 2015

Tech Innovation Improves Home Health’s Cost-Care Equation

Published by Home Health Care News
By Amy Baxter
October 30, 2015

Most Americans want to remain in their homes throughout retirement, yet the one thing that most hope to achieve by aging in place may be taking a toll on mental and physical health: independence.

Keeping seniors healthier—and happier—is a priority for health care agencies, but keeping seniors engaged and feeling healthy in the home setting can be extremely challenging. The consequences of isolation can negatively impact not only seniors’ health, but drive up costs to the provider and health system at large.

Nearly 2 million Americans over the age of 65 rarely or never leave their homes, according to research from the Journal of the American Medical Association (JAMA).They are more likely to be depressed with serious chronic conditions like cardiovascular disease or dementia, research shows. This population, often referred to as “shut-ins,” frequently relies on home health care services, but the social consequences of living alone with limited access to the outdoors and social events are far-reaching.

Shut-ins No Longer Shut Out

Selfhelp Community Services, Inc. is one health care service provider trying to address this issue with seniors in New York City. While the non-profit organization originally began to take care of victims from World War II, it has since grown to offer a number of services, including senior centers, affordable housing, naturally occurring retirement communities (NORC) programs and home care, to serve about 20,000 people.

It’s most innovative approach to helping homebound seniors is its virtual senior center, a system that offers live, interactive classes and exchanges for seniors in New York City, Chicago, Baltimore and San Diego. The system utilizes a 22-inch touch screen desktop computer that goes into the home of an isolated senior. Several organizations act as referrals for the virtual senior center, and an agency can help seniors arrange to have the system brought into their home.

Instead of focusing on the location of a center, Selfhelp has shifted to providing services wherever a senior may be living. This approach is part of what Stuart Kaplan, CEO of Selfhelp, refers to as “blended care,” which integrates housing and health care. This approach mirrors the changing payment methods by the Centers for Medicare & Medicaid Services (CMS) by moving toward integrated health care measures.

“We espouse that we are living at the intersection of social housing, affordable housing and health care,” says Kaplan. “Technology is one aspect that fits within the blended services and ultimately should fit into a payment system of bundled payments.”

For adults who once spent their days alone, the virtual center is life-changing, according to Kaplan.

“The virtual senior center was developed for a specific population who are isolated and at home due to health conditions or other disabilities,” Kaplan told HHCN. “They cannot get out of their homes to come to the senior center. We bring the activities of senior centers into the living room to seniors who are isolated and living at home.”
From music and art classes to yoga, the center provides seniors an entry into an engaging space without leaving home. Kaplan says the programming is the most important component of the center, but seniors have formed their own groups outside of classes as a result.
“One of the keys of keeping this vibrant and attractive to seniors is having somebody who organizes the programming,” Kaplan explains. “It’s just like having a television station. One of the benefits that we have found is that once somebody starts using the center, they form their own chatrooms and start social interactions outside the classroom, which further combats isolation. The majority of seniors who are participating are now talking to each other and using other adaptations.”

Virtual World, Real Results

The results of the virtual centers are undeniable, Kaplan says. Currently, just over 250 participants utilize virtual senior centers in their homes, with 83 as the average age of a user. A study conducted by Selfhelp of this population revealed that engaging in the centers improve health, attitude or the feeling of being healthier in many.

“When we ask people if it improved their quality of life, 97% of participants said yes,” David Dring, executive director of Selfhelp Innovations, told HHCN.

The survey asked participants if they lacked companionship. After some time with the virtual center, Selfhelp reduced those feelings by 60%. The effect on feelings of isolation was even more dramatic, with an 85% reduction among participants.

While the most immediate impact of engaging with the center is on mental health, seniors perceived themselves as healthier once they were involved, which may mean they need fewer health care services, says Dring. Virtual senior centers could also have bigger implications for telehealth and remote monitoring, which could lead to fewer hospital visits and lower care costs.

When asked to self-report their health status, 51% of seniors engaged with virtual centers increased their status, Selfhelp found.

“That indicates that the higher they are on that scale, the fewer health services they consume,” Dring told HHCN. “People who feel better about themselves will go to the doctor less and with a better attitude.”

Kaplan expects that as more baby boomers enter retirement, technology will play a critical role in overcoming some of the debilitating effects of isolation among homebound adults. In fact, the role of technology could revolutionize how seniors age in place.

“From a population standpoint, as younger seniors age, technology will become more and more the norm for the reason that they are already engaged,” Kaplan says. “They will be calling for technology to make it easier for them to live at home. The development of apps going on right now and how that is heading into the health care world, we’ve only scratched the surface in the use of tech.”

However, the program, which currently receives grants from the Consumer Electronics Association Foundation and the AARP Foundation, only serves a small population and faces a huge funding hurdle to expand, says Kaplan. The cost to seniors is about $600 to purchase the software and touch screen device, while service runs about $60 per month.

Many homebound seniors are Medicare beneficiaries, which does not pay for technology and systems like the virtual senior center. Medicare will typically cover medical devices that can make it easier for seniors to get around, but many still lack the ability to get outdoors on their own.

Why it's time to redefine the care team

Published by Healthcare IT News
By Eric Wicklund
October 30, 2015

Picture this: Every member of a patient's care collective – family, friends, home health providers, specialists, therapists, even pharmacists – can see what's happening when appropriate and receive alerts about that patient when necessary.

"Everyone involved has their own view of what is happening and each view is different … and important," said Sean Slovenski, CEO of Intel-GE Care Innovations. "They all play a part."

That scenario is part of what would make an informed, digitally-connected care team so powerful. Traditionally, however, care teams have for the most part existed within a hospital or clinic.

But there is evidence that's changing.

Mobile, telehealth tools

Thanks to digital health tools and the trend toward delivering care outside the hospital or clinic, some providers are already exactly what a care team is and how it operates.

Medical devices, mobile tools, sensors, telehealth services and remote monitoring products, in fact, are helping connect otherwise disparate people who comprise a care team via real-time smartphone communications, portals and, in some cases, mobile access to the electronic health record.

To Paul Kusserow, CEO of the home healthcare company Amedisys, these connections are a boon to both patients and providers.

[Related: 5 ways to fuel patient engagement.]

On the clinician side, that means extending monitoring and treatment into patients' homes.

"Technology has allowed us to access patients in more remote locations and allowed us to capture data on our patients that can be used to provide for the best health outcomes," Kusserow said.

The flip side? Patients benefit by being safer and more connected in their homes.

"Biometric monitoring and passive sensors, for example, allow patients to feel more at ease knowing they are connected to care providers and socially to their loved ones and family," Kusserow added.

Remaining challenges

The primary driver in harnessing care coordination and other IT tools has been to address gaps in care – such as when a patient moves from one location to another, or responsibilities are handed off from one member of the care team to another, or a message or data needs to be sent.

Technology has helped ease those transitions, Slovenski and Kusserow agreed, but it hasn't solved all the issues, and sometimes it has created new ones.
Imagine an app that doesn't work properly, or can't access the data a home health aide needs to properly treat a patient. How about a home health monitoring device that isn't accurate or reliable, or one that is hacked or rendered useless by malware?

"The main concern will be accuracy and the ability to simply work," Kusserow pointed out. "It is of paramount importance that these technologies provide highly accurate data and actionable analytics to decision makers. At the end of the day, the failure to do so directly impacts the well-being of the patient. If it all works, the relationship between the patient and care provider should be strengthened; it allows more people to become caregivers and patients to be more comfortable."

To that end, last month Intel-GE Care Innovations partnered with the Stanford Center on Longevity to host "The CI Hackfest: Redefining the Care Team." The event sought to highlight various technologies available to care providers, be they clinicians, family members or home healthcare workers.

Slovenski said the focus of the event wasn't necessarily on the technology itself, but on how it's being used to understand the human dynamic in all of this.

"You're in an environment where you want to lock eyeballs with people," Slovenski said. "But that environment is changing."

That's where the care team comes into play, he explained, and why it's important to create a network that motivates each member to participate. How can caregivers use technology to give the clinician a better sense of the patient's life in between the tests, visits and readings? And how can they motivate the patient to follow a care plan when he or she is out of the hospital and away from the doctor's office and health aide?

Another issue: payment models. Healthcare hasn't gotten around to figuring out how to pay doctors for their time away from the patient, so doctors are more inclined to resort to visits and procedures that they can be paid for.

"Reimbursement for these technologies should mirror the way we are being reimbursed, with a focus on quality," Kusserow said. "If these technologies drive great clinical quality and improve outcomes of patients, then there is a case for reimbursement."

Only as complicated as need be

Even though the latest and greatest apps, devices, remote monitoring, mHealth and telehealth tools are enabling a new, more collaborative and informed care team, those products have natural limitations.

"Technology can only go so far," Slovenski said. "If you get to the root, it's a motivational issue. Find out what works and what doesn't – it's definitely not a one-size-fits-all approach – and fashion a care plan around that."

That's why it's important to expand and redefine the care team – and include all of the players in the plan.

It may be as complex as a smartphone-based alert system that routes to the right caregiver at the right time in case of emergency, or as simple as a reminder slipped into a home health monitoring kit to gently nudge both patient and nurse to step on the scale each day.