HIT 4 QI:
Technology Enabled Aging in Place
National Health Policy Conference
February 13, 2007
Shannah Koss, Vice President
Health Information Technology
Avalere Health LLC
Avalere Health LLC | The intersection of business strategy and public policy
Long Term Care Faces Crisis
Several trends in the coming years will strain the long term care spectrum and its
ability to provide adequate high quality services
 Demographic shifts resulting from the aging baby boomer generation
» 65+ population to be 20% of population by 2030; disproportionately women
and minorities
 Institutional capacity and informal caregivers are insufficient for anticipated
growth
 Limited LTC insurance and financial planning leaves much of the population
unable to afford adequate services
 Continued Increases in public expenditures on LTC are highly unlikely
 Patchy reimbursement for LTC services and varied eligibility for programs makes
expansion of services difficult
 Social Security solvency and changes in Medicare coverage and benefits
exacerbate the problem
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Expanding Aging in Place Options Could Reduce Stress on the
LTC System
 The aging in place model emphasizes the least restrictive environment and
maximizing independence through assistance with daily functioning
 Aging in Place can help to alleviate the anticipated strain on LTC
» Reduced need for institutional options
» Reduced pressure on family caregivers
» More efficiently utilized physician time, office visits, and other benefits
 Technology can foster Aging in Place models and address the particular needs
of this population as distinguished from those requiring acute care
» Individual’s functional limitations, both physical and mental, will not improve
to previous level of self-sufficiency
» Individual often unable to recognize and/or seek treatment for minor illnesses
and injuries that can develop into life threatening medical conditions
» Needed services cut across a continuum from social to clinical services
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Aging in Place Could Support Quality “Touch points” in LTC
 Population with multiple co-morbidities
 Patients experience many care setting transitions
 High percentage of patients with cognitive challenges that emphasize surrogates
and related complexities
 Fragmented nature of sector
» Assisted living, hospice, skilled nursing, community based, home health
» Lack of communication among entities
 Many stand-alone independent facilities
 High turn over of LTC staff
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Technologies Can Enable Aging in Place


Assistive
Devices

Enable physicians with
ability to manage and
synthesize information
 Allow the individual
to remain engaged in
his or her own care
Reminders and navigational tools allow
individual to maintain daily function in a
safe environment
Traditional
Devices
Administrative
Applications
Lay a foundation for other
technologies enabling the
exchange of information
 Maintain vital signs and
transmit data to providers
Individual /
Caregiver
PatientCentered
Software
Early
Warning
Detection
 Monitor behavior
patterns to help
prevent acute
episodes
© Avalere Health LLC
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Technology Options
Assistive technologies
 Navigational tools make it easier for individual
to move around the home
» Stair lifts
» Seat lifting chairs
» Grab bars
» Anti-slip rugs
» Motion sensors and
» remote-controlled household controls
 Reminders prompt individual to conduct daily
activities
» Medication reminders
» Hydration reminders
Traditional Devices
coupled with data
transmission capability
 Implantable devices stream data to providers
Early Warning Detection
 Behavior portraits monitor behavior and detect divergences
 Wander management monitors and locates individual’s movement
 “Smart” scales and toilets detect abnormal changes in key characteristics
» Pacemakers
» Defibulators
 Worn devices automatically or manually transmit data
» Glucose monitors
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Technology Options (cont.)
Patient-centered
software applications
 PHR-enabled TVs allow the individual to view and augment medical
Administrative
applications for
providers
 Management tools allow physicians to sort through and manage
information
 Health Buddy assesses physical and emotional health of the individual
transmitted data
 System alerts notify provider when attention to patient is needed
© Avalere Health LLC
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HIT Enabled Aging in Place Supports Quality Improvement
Patient Centeredness

Patient remains independent and avoids
institutionalization

Patient empowered to administer and manage his or her
own healthcare
Prevention of Acute Episodes
Acute episodes and life-threatening events avoided
Quality Health Care
Focus on prevention, rather than invasive procedures
Monitoring and Treatment Adherence




Physician monitors patients in more efficient manner
Treatment adherence deficiencies noted and addressed
Data collection tracks patients over time
Generated data builds evidence-base
© Avalere Health LLC
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Challenges Remain but Promising Models Also Exist
Challenges
Promising Initiatives
 Limited infrastructure
 VA-like initiatives
 Lack of investment in HIT
 Industry Efforts - Continua
Health
 Lack of coverage models that
enable individual to outfit their
homes
 Fragmented and isolated public
funding streams
 No savings models or incentives
 Special Needs Plans (SNPs)
 Money follows the person
 PACE model expansion
 HIE/RHIO infrastructure
expansion
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New Policy Directions?
 LTC HIT Medicare and Medicaid demonstrations with cost-effective technology
enabled LTC services
» Alternative funding options
» Revised certification criteria - staffing, frequency of visits, severity of illness
» Certified technologies
 Flexible coverage
» Include technology purchases
» Maintain care setting neutrality
 Risk assessment for appropriate care and technology determination
 Finance reform
» Combine funding streams
» Personal accountability and contribution
© Avalere Health LLC
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