There’s no getting around it: we’re all getting older. Nearly 100 million people in the United States are over the age of 50, and those over the age of 65 make up the biggest, most expensive user group of healthcare. But older people today aren’t like older people of a few generations ago, and that means our methods of tailoring healthcare and technology to serve them in a way that reflects our shift towards value-based care needs to be focused on the people first, technology second, designing solutions around specific needs.
At the Aging 2.0 conference in San Francisco, the conversations focused on this demographic inevitably focus on the digital health innovations that have touched many other consumer groups -- from increased independence of seniors living at home to the support tools their caregivers need and remote-monitoring solutions that lead to more efficient doctor visits and reduced hospital admissions.
“In healthcare, there is a clear shift in consumption, and its mainly from a consumer we don’t hear a lot about: the aging consumer. There are a lot of attitudes of stereotypes, and they are still less well known,” Jaana Remes, an economist and partner at the McKinsey Global Institute, said at the event. “There is more equality, more diversity, they are more likely to be working later, more likely to be single, they are the most educated older generation yet, and they are much more likely to be tech savvy.”
That means the apps, remote-monitoring systems and connection platforms to their care teams should be designed with the idea that they will actually use it, Remes said.
“We need to make things that are suitable, particularly for the 75 and older crowd, to customize their needs,” Remes said. “Fewer younger people are taking care of their parents.”
Unsurprisingly, the demand for home healthcare services is increasing, with the global market valued at nearly $229 billion in 2015 with the expectation of reaching $391 billion by 2021, according to a new report from Zion Market Research. This includes private caregiving, telehealth, medical devices and therapy services.
For those who are at home, and those helping them, tools that improve quality of life and healthcare delivery efficiency are paramount. As a number of laws have been passed in the last year that set us on the course of value-based versus fee-for-service care, its especially important to look at the biggest consumers of healthcare.
“Life expectancy has changed dramatically in the US, but while people are living longer, they aren’t necessarily living healthier,” said Dr. Bruce Chernof, CEO of the Scan Foundation, an aging and long-term care charity organization. “Maybe they are living with higher function and longer, but they are living with more chronic diseases. Where could tech play a role?”
While half of adults 65 and older will meet Medicare nursing home eligibility, the vast majority will remain in their community, and that means they are going to need support to stay there.
“There is enormous opportunity both to reimagine how to deliver care and the types of tools and technologies necessary to succeed in this new environment,” Chernof said.
Since families tend to be smaller these days, and older adults more likely to be single than earlier generations, there is much more pressure on those providing caregiving support – and about two-thirds of people receiving at-home care are getting it from unpaid caregivers like family and friends.
“The need for technology-enabled caregivers and care support goes up,” said Chernof. “So we have to look mainly at ‘what is the problem I am trying to solve?’”
Chernof said healthcare providers tend to exert minimal efforts towards integrating social services, and, furthermore, they don't know exactly how those services will add value. For example, doctors separate out behavioral health from other medical health issues when delivering care, or refer people to services that can’t even accommodate them. Technology designed to integrate multiple aspects of healthcare could save time, money and lead to better health outcomes.
“People come up to me all the time with 1.0 technology solutions in a 2.0 problem environment,” he said. “Slapping an app on Meals on Wheels is not a 2.0 solution. Figuring out the different reasons why someone is hungry in the first place is, and designing technology tools around that – like how to get them in touch with transportation, how to get them in touch with their community, what sort of support they need at home – those are 2.0 solutions.”
Bringing the tech in: meeting industry needs
So how is the industry responding to these demographic trends and changing needs? In a panel discussion among leaders from the aging and senior care industry, the consensus was they want to see innovations that use digital health tools to improve care outcomes, but it needs to come at the industry the right way.
“On the pure technology side, it’s simple things like a dashboard report that family members can access that indicate what sensors at home they can interact with, enabling them to track patterns at home, so we can have the family get together and talk, rather than having to bring someone in every few weeks or months and try to figure out the problem moving backwards,” said Lily Sarafan, CEO of Palo Alto-based home care company Home Care Assistance.
Interoperability of new technology is especially useful, members of the panel said, especially in an ecosystem with many challenges such as proprietary information silos and reimbursement policies.
Dan Hirschfeld, president of Genesis Rehab Services, said this creates an opportunity for innovators to think about ways they can consolidate data.
“As an industry overall, we are very siloed. If you look at the acute setting and the post-acute world,I think there are 10 descriptive settings out there, and Medicare recognizes six of those for reimbursement,” he said. “I can’t wait for the day when the technology and the data to share it aligns with laws, because it does create a lot of issues for the provider, and, of course, the patient.”
Building on that, Bill Mills, founder of Chronic Care Management, which serves those at the in-between moments of care, said he sees places where EHRs are starting to be more open to connect with innovative solutions.
“Epic, for instance, and athenahealth have open APIs and there are a lot of ways for innovators to figure out how to enable these pretty siloed technologies to integrate,” he said.
Hirschfeld said he is looking for tools that bring patients back into the center of the conversation about their care.
“In our world of nursing homes, you have such a frail, elderly people who are of what we call it ‘learned dependence’ – I’m going to help you bathe, eat, get meds. That's counterindicative of what we really want them to do,” he said. “We want them to learn independence. That is patient engagement. So, we really have to work with them to make sure they have a stake.”
As far as the news around home care as the next popular place for entrepreneurs to get into and raise money, Sarafan cautioned to manage expectations – if they are trying to get into the aging and senior care market, they should really take the theme of maturation to heart.
“We definitely view it as a rising tide. It’s good for everyone when there is more capital and innovation, but having lived my entire life in Silicon Valley, I’ve seen all the trends, and something I would caution any startup getting into care is, get out of the startup stage and try to mature as a company.”
Challenges to adoption
As innovators look to get into the space, they need to figure out the correct pathway to reach aging and senior care companies, the panel said.
“We often get requests for pilots from companies who don't understand that what they are trying to pilot is something we've already developed or that we already have a solution around, or we have companies that have created a really cool hardware product but have demonstrated zero design thinking when it comes to what an 85-year-old would be looking for in terms of the usability of that product,” said Sarafan. “So, we're really going to need to see much more than just an idea. I still believe that ideas are free and execution is priceless, so we need to see traction.”
And integrating the technology can’t come as a burden to those providing care, either.
“Clinicians, by and large, do not like change, so you will need to find those who embrace technology,” said Hirschfeld. “We have the data, we have the clinical libraries, we have care pathways that we have developed … so we need technology that clinicians and staff can use.”
Trish Barbato, senior vice president of retirement and long term care company Revera, said preparing for the onslaught of data that comes with new technology adoption can be daunting in her industry.
“The huge challenge, I see, is there is going to be a day where there is a sensor in everything – a sensor in beds, furniture … everything will be sort of queued up, and what do we do with all that data? You can't do alerts from six different systems. You need somehow to make it easier,” she said. “We need to figure out a way to use information in a way that supports a staff member to provide care in that moment and know what he or she is supposed to be doing, without making it more confusing.”
Barbato said while a number of tools are addressing that, we’re not quite there yet.
“We need to take that information and figure out what makes it relevant: no human being can take all that data and figure out what to do with it.”
With the advent of technology comes some hesitation, too. Sarafan pointed to the new levels of accountability that some caregivers and clinicians may not necessarily want.
“What happens when this data becomes clear and now it's absolutely transparent as to why our staff did not respond in the appropriate way; that our resident did not receive the proper protocols in that moment?” she said. “There's almost a preference to have a little bit of a vacuum, a black box because once the data is available, then everyone is that much more accountable. And I think the piece that addresses that are appropriate pilots for providers in an ecosystem that demonstrate [how] the value and the benefits to that integration far exceed the potential risks and liabilities associated with it.”
Barbato added that staff and patients alike may be nervous around technology at first – she gave an example of nurses using mobile devices for scheduling and patients using iPads for education – but once it’s in their hands, there usually isn’t a return to life without the technology.
“I mean, five years ago, we didn’t even have wifi in our buildings, so we’re just now kind of getting our head around what it means to have technology-enabled staff and residents. But we’re going to get to a place where they are just showing up with devices and expecting us to have them integrate with their care.”
Once a piece of technology that could improve senior care has been identified, pilots and ongoing evaluation should be an important part of the adoption, the panel said. But the hardest part is figuring out exactly what type of technology, or what area they want it to serve, would best capitalize on the opportunities this industry presents.
Mills pointed to the fact that physicians will soon have to elect how they are going to comply with MACRA, so choosing the pathway to how they deliver value-based care could go a lot of ways.
“There is a lot of activity right now that is really trying to jockey for position to figure out paths to do ROIs and technology evaluation,” he said. “One of the neat things I've heard is that the home is where a lot of the innovation is happening.”
Apps that allow patients and caregivers to integrate chronic care management with everyday life, or sensors providing data that let the doctor know what is going on when they aren’t available (the so-called “white space” of patient care) could be the most valuable.
“Where chronic care management fits in, is that a lot of times the plan the physician puts forth falls off when the patient goes home, so that's one area that has a very high degree of interest right now from risk-taking providers and those who are kind of dipping their toe and try to figure out, how, ‘Gee, I’m going to do my best in all these visits, but can you help me with all the rest?’” Mills said.
Sarafan said building backend technology to create analytics and systems to track health of their patients, schedule staff, match the right caregiver or clinician to the right patien,t and understand people to create a more personalized approach is critical to creating more value in care.
“Collecting better data that we can share with our 10,000 referral partners around the country on what’s happening in that white space, what happens in between when someone sees their healthcare provider two or three times per year because of an emergency situation or a check-up, and now we’re potentially interacting with a patient 24/7 for months or even years,” said Sarafan. “That’s what puts us in the best possible situation to share data across players in the ecosystem and prevent preventable hospital admissions.”