When talking to people about the personal emergency response system (PERS) industry, I often reference 30-year-old TV ads that showed seniors who’d fallen and couldn’t get up. This underscores the fact that until recently, the PERS industry has been as technologically stagnant as those ads. And metaphorically, they point out that people in that situation were pretty much alone in addressing the issue.
But much has changed, thanks to the promise of mHealth. Providers are now looking to the industry to reduce the threat of falls at home – a significant clinical and financial expense – and to improve patient engagement efforts. And they're doing this within the workings of the accountable care model of healthcare.
Falls among seniors represent a major expense to the healthcare system. With the CDC reporting that one in three adults over the age of 65 falls every year, and with an ever-increasing number of people aging, it's projected that by 2020 the annual direct and indirect cost of fall injuries will reach $54.9 billion.
In the world of fee-for-service healthcare reimbursement, the desire to address falls was not a principal concern, in part because the costs related to falls represented a portion of a larger revenue stream. But with healthcare evolving rapidly into a fee-for-value model, there is the new triple-aim to consider: keeping people healthy and independent (and out of the hospital), while simultaneously increasing patient engagement and decreasing overall care costs.
Addressing the triple-aim is where pioneering healthcare providers see the benefits afforded by the PERS industry, and they're actively implementing them as part of an ACO model.
At this year's American Telemedicine Association conference I talked with Bill Dunstan, president of Affilia Home Health, who is incorporating PERS devices into his Pennsylvania-based agency as part of Insignia Health's Patient Activation Measure (PAM) program and its related prescriptive for caring for larger populations of patients within his agency’s ACO setting.
Under the direction of the River Health ACO, Affilia is implementing PAM – a modeling tool that uses 10-13 questions to measure the knowledge, skills and confidence necessary for patient self-management – to place patients into one of four different levels of health activation. Based on PAM, Affilia can also project how much each patient will cost the ACO (on average), as well as identify the most effective care tools to be used in addressing long-term care.
Referencing PAM’s predictive modeling, Affilia has been putting together the components necessary to create the right home environment for discharged patients, by blending the necessary amount of patient oversight and engagement to keep patients out of the hospital and improve long-term outcomes, for a net result of reducing overall costs.
For non-compliant patients in levels 1 and 2 who have higher activation levels, PERS solutions combined with other methods of medical support have the capability to provide a low-cost, yet consistent level of both oversight and engagement.
For example, in Affilia a new fall prevention program called “Stable and Able” combines a patient assessment tool with customized patient education from nursing, physical therapy and occupational therapy staff members to provide patients with the tools they need to proactively prevent falls. Their PERS devices provide the right level of contact and support – in case patients need it.
Having the safety net of a PERS device also allows Affilia to address one of the primary catalysts to falls for patients: As the American Academy of Family Physicians notes, “the fear of future falls and subsequent institutionalization often leads to dependence and increasing immobility, followed by decreased quality of life.” If seniors or patients are afraid of falling, they tend to avoid moving, which leads to muscle atrophy and, consequently, a higher risk of falling.
The "Stable and Able" program has also been able to successfully leverage recent technology advancements within the PERS industry. Like the rest of the Health IT industry, the past five years have seen massive technology innovation and evolution in PERS solutions, with mobility and automatic fall detection chief among them.
Why are those advancements critical? From a mobility standpoint, very few PERS devices offer the capability for use outside the home. For active (or high-activation) seniors or patients, simple activities such as walking to the end of a driveway to get the mail or to the neighbor’s house to say hello become potentially dangerous because those actions would take them beyond the range of their PERS home base station – and access to help should they need it.
Likewise, activities such as trips to the grocery store or hairdresser – let alone trips across the country – render the traditional, home-based PERS device useless: the technology fails to help people as intended when the wearer is away from home. Added to that is the stark statistic that roughly 45 percent of all falls occur actually outside the home, and you’ve got a pretty good argument in support of a mobile PERS (M-PERS) device. This is especially if the intent in using the device is related to long-term oversight.
Automatic fall detection is something the PERS industry has only recently brought to market, though the statistics supporting it as part of the product solution are as obvious as those related to mobility: a recent study determined that 80 percent of PERS users can't activate the alarm on their device following a fall. In other words, 4 out of 5 falls render a person unable to physically press the button (they land on the lanyard, for example, and therefore can't reach it). Automatic fall detection addresses these issues; in the event of a fall, help is available whether or not the wearer is able to press the emergency button.
There are other long-term benefits to automatic fall detection technology, which when added to current M-PERS solutions have the potential to re-shape the way people will be able to proactively manage their own health. This component will be instrumental in helping non-compliant PAM level 1 and 2 patients as they move from places of recovery post-discharge into maintaining their own health long-term.
Automatic fall detection technology works through the use of sophisticated sensors and algorithms which are constantly running, monitoring the wearer’s activity and ready to – at a moment’s notice – activate the emergency call notification if the algorithm detects activity that suggests a fall has taken place.
Using that same technology makes available an array of other services to highly active seniors or patients who want to track and monitor their activity levels over the long-term. In addition to automatically detecting if the user has fallen and issuing an emergency notification, it can track the customer’s activity levels on a daily, weekly, monthly or even yearly basis – and compare those rates over time. While the patient then view his or her own activity levels, authorized caregivers, family members or healthcare providers can also virtually check in and ensure the activity levels of the wearer are maintaining consistent levels.
These mHealth tools will help healthcare providers like Affilia to offer programs such as "Stable and Able" to their patients and address healthcare’s triple aim challenge – keeping them healthy, at home and engaged with caregivers, all while reducing care costs.
Robert Flippo is CEO of MobileHelp, a Boca Raton, Fla.-based developer of M-PERS technology. He is a member of the board of directors of the Medical Alert Monitoring Association (MAMA) and a former executive with Motorola, Boca Research and Emergin.