By David Whitehouse
The news is constantly full of stories about medical breakthroughs that are helping us live longer but for many this has not translated to better. Aging brings its own challenges, but frequently this is compounded by increasing demands of failing health and a greater need to manage new diagnoses, understand new medications, negotiate limitations in function and all of this compounded by challenges to memory, concentration, adaptability, energy and mood. Polypharmacy sometimes creates problems of its own, rather than control the growing number of declining systems. Making changes to regimens that are poorly understood, instead of providing the rescues or positive outcomes that are hoped, just frustrates and frightens people already overwhelmed.
Changes in formulary that create unexpected copays at the pharmacy cause people to “leave” medications behind when they don’t have the readily available funds. Weather can deter or defer much needed and scheduled visits to the doctor, whether it is snow or freezing cold in the winter or allergies and heat in the summer. While the place people least want to be is the doctor’s office or the hospital the complexity of trying to “age well in place” seems to result in a constant flow of visits. Getting admitted to a hospital is disorienting and frequently leads to an unintended loss of functionality, hastening rather than forestalling decline. Not only do we have the most expensive dying of any country in the world, we have the most expensive, complex, fragmented and ill-designed care system for the elderly. What do people want? They want to have services that help them maintain their independence and to be valued as individuals not stereotyped because they are old, and they want to be at home, able to maintain their social relationships as best they can.
If we dare boldly we could deliver on this now. We could take their dream and turn it into a reality today. Two things are required; one an understanding of (and a willingness to embrace) what technology can do to assist us to remotely monitor, truly understand (at the individual level) and mange patients in their homes and two an alignment of the system to reimburse for “value” (clinical outcomes, financial outcomes, quality of life) beyond activity. The types of monitoring that can be done at home through simple readily available devices, blood pressure monitors, thermometers, scales, spirometers can not only give us insights to the situation when a patient “has an episode” but can more dynamically allow us to truly appreciate their individualized base-line, their normal variation and learn the unique exacerbants that are most critical in their life. When rescues are needed instead of bringing them to an emergency room to treat, then monitor and then reevaluate before sending home, rescue protocols that are ordered by their physician can be put in place and tracked and modified without taking the patient out of the house, giving them a greater sense of control of their own situation. All of this is powered by two way communication of data and messages both live and in text that let the patient know they are cared about, they are not alone, that their attempts to help themselves are being tracked for their safety. In addition new sensors that track the person as they go about their daily routine can give subtle and early cues as to changes in habits that signify pain, distress, or alterations in memory or mood. These create the deep insights that are truly personal, powered by machine learning algorithms that can help deliver on the promise of respecting the unique individuality of every patient and not just treating them as “yet another” diabetic or CHF patient.
This isn’t the future. For these patients who prefer this and are clamoring for it, this is here now, available, deployable, and affordable. So the question really is what does it take to turn hopes into reality – awareness and action. So if you are aware now, isn’t it time to act.
By Dr. David Green, MD. Pulmonary Medicine, Emerson Hospital
The promise and effectiveness of technology enhanced in-home care is tremendous. Through home monitoring, we are able to identify subtle changes in symptoms and behaviors that patients may not recognize themselves. This could be lower oxygen levels, a change in pulse, or even just signs of fatigue. In many cases the changes required are obvious and simple, such as taking an extra pill for a period of time, and do not need the attention of a physician. In other cases, these changes are critical to the patient’s well-being. By recognizing these critical changes promptly, treatment can be initiated to avoid major exacerbations that could lead to hospitalization. Whether minor or major, early intervention is crucial to helping the patient stay as healthy as possible, avoid the need to visit the doctor, or more importantly, the hospital emergency room.
The following is the first of a series of guest blogs from Senscio’s trusted advisors and thought leaders in the field of healthcare. We hope you find these articles stimulating.
By Soeren Mattke, Managing Director of RAND Health Advisory Services
As our population continues to live longer, it is no surprise that the challenge for providing effective and value-based healthcare is increasing. An older population, which is more susceptible to chronic diseases and general frailty, requires a different paradigm of healthcare than our current system had been optimized for. Traditional paradigms for medical treatment are focused on specific illnesses, with well-established protocols to address symptoms. These clinical guidelines, “if x then y”, are linear, developed by specialists who optimize for one disease, but generally do not consider the totality of a person’s condition. Optimizing for one disease often exacerbates issues with another. With an older population, we need to look at multiple diseases and comorbidity in a new way, customized for each person’s condition.
by Nicholas Toumpas, Principal Consultant at Karitsa Consulting Services, LLC, former New Hampshire Director of Health and Human Services
Over the past several years, we have seen an increasing awareness of the need for evolution of Medicaid-funded healthcare from traditional “fee for service” to accountable outcome-focused care. Through the help of technology, coaching, and improved protocols, in New Hampshire we have been able to drive this care from being clinic/hospital-based, to community based, and ultimately to in-home care and support. This has resulted in better outcomes, lower costs, and improved population health, while reducing the burden on physicians.
By Mike Charley, Chief Growth Officer
In the age of technology, chat bots, and electronic charting, the healthcare industry is seeing radical changes in its approach to patients. While these technologies are providing new ways to provide care, they may also be missing an important aspect of quality care.
By Mike Charley, Chief Growth Officer
In the age of social media and data mining, leveraging predictive models for better outcomes has become paramount for many organizations. That is true for healthcare professionals relying on mined data of actual patients to improve provider decisions.
Data gathering is the easy part. There is often so much that it can become overwhelming. That’s why data mining in the healthcare industry must be strategic. The key to being able to use the reams of data now available in the actual care of the patient is to have the data contextualized into “actionable information” in a real-time manner. This enables meaningful and relevant insights to be applied to the standards of care for the individual and for populations. Here are a few tips on how to start turning data in action.
By Mike Charley
The drive to transform the healthcare system from a volume based, fee-for-service structure to a value-based, “focus on outcomes” structure has been underway for several years. Escalating costs and imbalances between levels of care have jump started the movement to reform the health care payment system.
One of the first efforts in this arena has been the Accountable Care Organization (ACO) model. Pursuing this model has been a step in the right direction. Some ACOs have shown considerable progress in finding ways to deliver good health care while reducing costs. At the same time the model has demonstrated the many challenges in transforming health care.
By Bill Anderson
Readmissions are on everyone’s mind in the acute and post-acute care space, and people with chronic health conditions are 1.5 times more likely to be re-hospitalized within 30 days, 4 times more likely to have an emergency room visit, and cost 5.5 times more for annual care than those without complex or chronic health conditions. And the high costs of admissions—the financial costs—are where Senscio and our Ibis technology provide extraordinary value to primary and acute care providers.
By Piali De
Health Affairs released a Health Policy Brief in September on “Rebalancing Medicaid Long-Term Services and Supports.” The brief announced that instead of focusing on institution-based care, Medicaid is shifting to support community-based care and long-term care options. The driving factor in this shift is the desire to provide “true balance” for beneficiaries through a “comprehensive and flexible community-based long-term services and supports program.” This, the brief argues, will be a more humane and cost-effective approach to our current health care system.
By Piali De
During last week’s roundtable conference, I had the opportunity to engage with a variety of influential and thoughtful individuals on the topic of providing care for people with the most complex health concerns. I want to thank those participants for joining with me in what became a rich conversation on this topic that we all care about and for their immense contributions to the discussion.