Why Telemedicine is the Future in Senior Housing
Telehealth and telemedicine will be key features for future health care delivery and senior care. A National Business Group on Health survey in 2016 found that by next year, 96 percent of health systems will likely offer telehealth in their services. The use of electronic or digital technology can include teleconferences for doctors’ appointments to health monitoring devices such as fitness bands. Senior care could be improved through the use of technology, which can provide greater access to healthcare, better personalization and improved quality. With 50 percent of hospital readmissions being patients over the age of 65, improving care and access to care is vital. The Access Physicians telemedicine program, which provides acute care in conjunction with Kindred Healthcare, has estimated that over 600,000 patients will be cared for in 2017, saving $2.64 million in operational costs and reducing the mortality rate by 17 percent. The program has found that 99 percent of users felt the doctor spent a sufficient amount of time on their care; 95 percent felt the physician included them in their care decisions; and 100 percent felt their queries were answered to their satisfaction. With finance being the largest obstacle for wider implementation of telemedicine, the support of CMS and payers is critical for the practice to spread. Since 1997, Medicare has already provided reimbursement for telehealth services, though it is conditional. However, the introduction of telehealth programs should be carried out with care, given the insecurity of patients and care teams about potential disruption.

The 21st Century Senior Living Community is a series brought to you by CDW, a provider of technology solutions and services focused exclusively on serving the healthcare marketplace. The series takes a clear-eyed look at how leading providers and their partners are creating the next generation of senior living communities by raising the bar on services, design and technology.

Debate remains about the terminology, but one thing is certain: telehealth and telemedicine are becoming cornerstones of health care delivery and stand to significantly improve senior care.

A 2016 survey from the National Business Group on Health found that by 2018, 96% of health systems will be using some form of telehealth in their health care delivery. The term “telehealth” is a broad and often misunderstood one, and does not exactly inspire enthusiasm. Yet its sweeping qualities make it an easy concept to understand: it is the use of digital or electronic technologies in the delivery of health services.

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This can mean anything from teleconference doctor appointments to wearing fitness bands, like a Fitbit, that monitor personal behavior to build a health-related dataset.

It’s not surprising, then, that perhaps more than any other demographic, seniors could see the most upside from telehealth’s three key benefits: access, personalization, and quality.

“Fifty percent of hospital readmissions are actually from those over the age of 65,” said moderator Ginna Baik, strategic business development executive at CDW-Healthcare. “It’s becoming not only a pertinent but most important issue inside of health care in general, as well as the continuum of care in senior care.”

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How senior care benefits from telehealth

While there is still some debate surrounding the nuance in terminology, there is general agreement about the value of the technology and the degree to which it will continue to grow, particularly in senior care.

“There really are endless reasons why those greater than 65 have more difficulty accessing care,” said Dr. Eduardo Vadia, co-founder of Access Physicians, during a recent Senior Housing News webinar on the rise of telemedicine in senior housing. “This is a better approach to providing better access.”

The statistics tell the tale. Vadia’s Access Physicians telemedicine program — an acute care program in partnership with Louisville-based post-acute giant Kindred Healthcare (NYSE: KND) — projects more than 600,000 patients served in 2017, leading to an operational savings of $2.64 million and a 17% reduction in mortality rate. He wants to see more outcomes-based data, which will help sell the broader implementation.

The patient experience will, too. Travel time is a huge barrier to health care for seniors. Telehealth cuts that. Access’s program has a Net Promotor Score of +95, with patients expressing satisfaction in their care:

– 99% felt the doctor spent an adequate amount of time with them

– 95% felt the doctor included them in decisions

– 100% felt their questions were answered to their satisfaction

Fighting the cost barrier

While Vadia is encouraged by the program’s ability to deliver “elite care,” he noted that program longevity depends not just on finding clinical wins, but financial ones. This is critical because, as the panelists agreed, one of the largest barriers to widespread implementation is cost.

“What I think success looks like [in telehealth] is policy changes, and having CMS and payers really put some cash behind us, because money makes things move,” said Davis Park, director of Front Porch Center for Innovation & Wellbeing. The center is affiliated with Front Porch, which offers a variety of senior living options, including continuing care retirement communities (CCRC).

To expand upon the results Vadia has seen, Park noted that health care systems must be incentivized to support telemedicine delivery via new payment models.

“I personally think legislation needs to move in this direction,” Park said. “I think that we all should try to be as informed as possible so that we can advocate for these kinds of reimbursement models.”

Medicare has reimbursed for telehealth services since 1997, though conditions for reimbursement vary. Information is available at Center for Connected Health Policy, and individual addresses and ZIP codes required for reimbursement can be searched at www.datawarehouse.hrsa.gov.

For those wanting to launch their own telehealth programs, Park recommends talking to leadership in their organizations, and partnering with organizations in the community already using telehealth initiatives. Front Porch has used grant funding to develop telehealth initiatives in some senior housing settings, focusing on telemedicine and teledentistry.

“This is a very disruptive space, and your care teams are not going to like it,” Park said. “People are not going to be happy that you have a screen in one of your rooms or are wheeling them into people’s bedrooms. We need to be mindful about people’s insecurities about this.”

‘Just medicine’

Perhaps part of the insecurity is the use of language. It’s not just the confusion over the terms, with many not realizing that “telemedicine” is a subset of “telehealth.” The problem is also in the use of “tele.” Vadia wants to normalize telemedicine by driving out the prefix, so that patients, families, and doctors view it just as “medicine” — just another piece of the total medical offering.

Another panelist, Dr. David Lindeman, director of CITRIS Health, offered straightforward advice.

“Don’t sweat the terminology,” he said. “Just focus on what you’re doing.”

Lindeman’s experience with telehealth through CITRIS has been eye-opening. CITRIS stands for the Center for Information Technology Research in the Interest of Society, and works to bring together laboratory research at various University of California campuses with public and private institutions and investors to facilitate the development of new technologies.

But nothing sells like a personal experience. Lindeman uses telehealth as a patient member of Kaiser Permanente, and saves time by rarely going in for appointments, instead communicating via email.

“This has become expected,” he said. “When people do realize that they do not have to take an hour or two out of the day, a caregiver does not have to take an older adult in for an appointment, or staff has to be assigned to a senior living community to move to a location, it’s a game-changer. And I think it’s now become far more the norm.”

Written by Jack Silverstein