HIT 4 QI:Technology Enabled Aging in PlaceNational Health Policy Conference: 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


Long Term Care Faces Crisis: 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


Expanding Aging in Place Options Could Reduce Stress on the LTC System: 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


Aging in Place Could Support Quality “Touch points” in LTC: 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


Technologies Can Enable Aging in Place: Technologies Can Enable Aging in Place Individual / Caregiver Assistive Devices Administrative Applications Traditional Devices Patient-Centered Software Early Warning Detection Reminders and navigational tools allow individual to maintain daily function in a safe environment Lay a foundation for other technologies enabling the exchange of information Maintain vital signs and transmit data to providers Monitor behavior patterns to help prevent acute episodes Enable physicians with ability to manage and synthesize information Allow the individual to remain engaged in his or her own care


Technology Options: Technology Options


Technology Options (cont.): Technology Options (cont.)


HIT Enabled Aging in Place Supports Quality Improvement: HIT Enabled Aging in Place Supports Quality Improvement Quality Health Care Patient Centeredness Patient remains independent and avoids institutionalization Patient empowered to administer and manage his or her own healthcare 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 Prevention of Acute Episodes Acute episodes and life-threatening events avoided Focus on prevention, rather than invasive procedures


Challenges Remain but Promising Models Also Exist : Challenges Limited infrastructure Lack of investment in HIT Lack of coverage models that enable individual to outfit their homes Fragmented and isolated public funding streams No savings models or incentives Challenges Remain but Promising Models Also Exist


New Policy Directions?: 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