Long Term Care Faces Crisis
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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 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 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 Avalere Health LLC | The intersection of business strategy and public policy © Avalere Health LLC Page 2 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 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 » More efficiently utilized physician time, office visits, and other benefits » Assisted living, hospice, skilled nursing, community based, home health 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 » Lack of communication among entities Many stand-alone independent facilities High turn over of LTC staff » 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 © Avalere Health LLC Page 3 Technologies Can Enable Aging in Place Technology Options Assistive Devices Enable physicians with ability to manage and synthesize information Allow the individual to remain engaged in his or her own care Lay a foundation for other technologies enabling the exchange of information Assistive technologies Maintain vital signs and transmit data to providers Individual / Caregiver PatientCentered Software Early Warning Detection 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 Reminders and navigational tools allow individual to maintain daily function in a safe environment Traditional Devices Administrative Applications © Avalere Health LLC Page 4 Monitor behavior patterns to help prevent acute episodes 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 © Avalere Health LLC Page 5 © Avalere Health LLC Page 6 1 Technology Options (cont.) Patient-centered software applications HIT Enabled Aging in Place Supports Quality Improvement PHR-enabled TVs allow the individual to view and augment medical information Patient Centeredness Health Buddy assesses physical and emotional health of the individual Administrative applications for providers Management tools allow physicians to sort through and manage transmitted data System alerts notify provider when attention to patient is needed 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 Page 7 Challenges Remain but Promising Models Also Exist Challenges Challenges New Policy Directions? Promising Promising Initiatives Initiatives Limited Limited infrastructure infrastructure VA-like VA-like initiatives initiatives Lack Lack of of investment investment in in HIT HIT Industry Industry Efforts Efforts -- Continua Continua Health Health Lack Lack of of coverage coverage models models that that enable enable individual individual to to outfit outfit their their homes homes Fragmented Fragmented and and isolated isolated public public funding funding streams streams No No savings savings models models or or incentives incentives © Avalere Health LLC Page 8 LTC HIT Medicare and Medicaid demonstrations with cost-effective technology enabled LTC services » Alternative funding options Special Special Needs Needs Plans Plans (SNPs) (SNPs) Money Money follows follows the the person person » Revised certification criteria - staffing, frequency of visits, severity of illness » Certified technologies » Include technology purchases PACE PACE model model expansion expansion HIE/RHIO HIE/RHIO infrastructure infrastructure expansion expansion Flexible coverage » Maintain care setting neutrality Risk assessment for appropriate care and technology determination Finance reform » Combine funding streams » Personal accountability and contribution © Avalere Health LLC Page 9 © Avalere Health LLC Page 10 2
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